Method and system for providing dynamic orthodontic assessment and treatment profiles

ABSTRACT

Method and system including receiving one or more parameters associated with an orthodontic condition, receiving a treatment goal information associated with the orthodontic condition, and providing a predefined template associated with the received treatment goal information, wherein the predefined template includes at least one orthodontic condition related information, are provided.

RELATED APPLICATIONS

The present application claims priority under 35 USC § 120 to pendingapplication Ser. No. 10/788,635 entitled “Dental Data Mining” filed onFeb. 27, 2004, and to application Ser. No. 11/379,198 entitled “Methodand System for Providing Indexing and Cataloguing of Orthodontic RelatedTreatment Profiles and Options” filed Apr. 18, 2006, the disclosure ofeach of which are incorporated herein by reference for all purposes.

FIELD OF THE INVENTION

The present invention is related generally to the field of orthodontics.More specifically, the present invention is related to methods andsystem for providing dynamic orthodontic assessment and treatmentprofiles.

BACKGROUND

A primary objective of orthodontics is to realign patients' teeth topositions where the teeth function optimally and have an aestheticappearance. The goal of a doctor is to take the patient from theircurrent condition (“initial” or “starting dentition”) to a finalcondition (“treatment goal”). The result achieved is known as the“treatment outcome.” There may be many ways to achieve the goal andthese are known as “treatment options.” The methodologies used by thedoctor to get the patient to the goal are known as “treatment plan.”

Often times, doctors establish the goal as “ideal” and discontinuetreatment when they are as close as they can possibly get to the ideal.However, more recently with the growing use of 3-D computer graphicssoftware services and programs in dentistry, the doctor can actuallyestablish a custom treatment goal specific to each individual patient,and this goal may be a limited treatment goal and not ideal in everycomponent of the bite. This is important because if the doctor is ableto achieve 100% of the intended limited goal, the treatment may still bedeemed a success, whereas it may be possible that if the doctor onlyachieves 75% of a completely “ideal” treatment goal, the treatment mightnot be deemed a success even though the amount of measured improvementon an absolute scale in the latter situation might be higher than in thelimited treatment situation.

Typically, appliances such as fixed braces and wires are applied to apatient's teeth to gradually reposition them from an initial arrangementto a final arrangement. The diagnosis and treatment planning process oforthodontic cases can be imprecise as the final dentition of a patientis based on the knowledge and expertise of the treating doctor inassembling various parameters in an assessment of each patient'scondition and in a determination of a final position for each tooth.Different clinicians will vary in their definitions of individualorthodontic parameters and their definition of how a case should ideallybe treated will also often vary.

To overcome some of these subjective issues, various indices have beenused to more objectively define a patient's initial dentition and finaloutcome. For example, the PAR (Peer Assessment Rating) index identifieshow far a dentition is from a good occlusion. A score is assigned tovarious occlusal traits which make up a malocclusion. The individualscores are summed to obtain an overall total, representing the degree acase deviates from ideal functional alignment and occlusion. The PARgrader is then calibrated to a known standard set of orthodonticconditions so this individual is able to rate new cases similarly.

In PAR, a score of zero would indicate ideal alignment and positioningof all orthodontic dental components as defined by generally acceptedocclusal and aesthetic relationships the orthodontic community hasadopted, and higher scores would indicate increased levels ofirregularity. The overall score can be recorded on both pre- andpost-treatment dental casts. The difference between these scoresrepresents the degree of improvement as a result of orthodonticintervention. In addition to the PAR index, other indices may be usedsuch as Index of Complexity Outcome and Need (ICON), Index ofOrthodontic Treatment Need (IOTN) and American Board of Orthodontics(ABO) indices. These indices also rely on individual dental measurementsin order to derive an assessment of deviation from an ideal.

In view of the foregoing, it would be desirable to have methods andsystems to provide dynamic orthodontic related assessment, diagnosisand/or treatment profiles.

SUMMARY OF THE INVENTION

In one embodiment, method and system including receiving one or moreparameters associated with an orthodontic condition, receiving atreatment goal information associated with the orthodontic condition,and providing a predefined template associated with the receivedtreatment goal information, wherein the predefined template includes atleast one orthodontic condition related information are provided.

These and other features and advantages of the present invention will beunderstood upon consideration of the following detailed description ofthe invention and the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A shows one exemplary dental data mining system;

FIG. 1B shows an analysis of the performance of one or more dentalappliances;

FIG. 1C shows various Movement Type data used in one embodiment of thedata mining system;

FIG. 1D shows an analysis of the performance of one or more dentalappliances;

FIGS. 1E-1F show various embodiments of a clusterizer to generatetreatment plans;

FIG. 2A is a flowchart of a process of specifying a course of treatmentincluding a subprocess for calculating aligner shapes in accordance withthe invention;

FIG. 2B is a flowchart of a process for calculating aligner shapes;

FIG. 3 is a flowchart of a subprocess for creating finite elementmodels;

FIG. 4 is a flowchart of a subprocess for computing aligner changes;

FIG. 5A is a flowchart of a subprocess for calculating changes inaligner shape;

FIG. 5B is a flowchart of a subprocess for calculating changes inaligner shape;

FIG. 5C is a flowchart of a subprocess for calculating changes inaligner shape;

FIG. 5D is a schematic illustrating the operation of the subprocess ofFIG. 5B;

FIG. 6 is a flowchart of a process for computing shapes for sets ofaligners;

FIG. 7 is an exemplary diagram of a statistical root model;

FIG. 8 shows exemplary diagrams of root modeling;

FIG. 9 show exemplary diagrams of CT scan of teeth;

FIG. 10 shows an exemplary user interface showing teeth;

FIG. 11 is a block diagram of the overall system for practicing thevarious embodiments of the present invention;

FIG. 12 illustrates a tabular representation of the indexing systemstored in the storage unit of FIG. 1 in accordance with one embodimentof the present invention;

FIG. 13 illustrates a representation of possible treatment goals for anygiven orthodontic case in one aspect of the present invention;

FIG. 14 illustrates a matrix representation for the possible treatmentgoals shown in FIG. 13 formatted in accordance with the tabularrepresentation shown in FIG. 12 in accordance with one embodiment of thepresent invention;

FIG. 15 illustrates the lower arch length category for use in theindexing system in accordance with one embodiment of the presentinvention;

FIG. 16 illustrates the selection process display for use in theindexing system for the identified primary concern as “buck teeth” inaccordance with one embodiment of the present invention;

FIG. 17 illustrates an exemplary selection process display 1700 forcapturing one component of the sagittal dimension discrepancy for thepatient's right side in one embodiment of the present invention;

FIG. 18 illustrates an exemplary selection process display 1700 forcapturing one component of the sagittal dimension discrepancy for thepatient's left side in one embodiment of the present invention;

FIG. 19 illustrates an exemplary selection process display 1900 forcapturing one component of the vertical dimension in one embodiment ofthe present invention;

FIG. 20 illustrates an exemplary selection process display 2000 forcapturing one component of the horizontal/transverse dimension in oneembodiment of the present invention;

FIG. 21, an exemplary selection process display 2100 for capturing onecomponent of the arch length discrepancy category in accordance with oneembodiment of the present invention;

FIG. 22 illustrates an exemplary selection process display 2200 forcapturing another component of the arch length discrepancy category inaccordance with one embodiment of the present invention;

FIG. 23 illustrates an exemplary patient summary display 2300 displayedon terminal 1101 for use in the indexing system in accordance with oneembodiment of the present invention;

FIG. 24 illustrates a patient database 2400 in accordance with oneembodiment of the present invention;

FIG. 25 illustrates the selection process for representative componentsfor use in the indexing system in accordance with an embodiment of thepresent invention;

FIG. 26 illustrates an exemplary series of database addresses generatedby combining the initial condition address with the treatment goaladdress in one embodiment of the present invention;

FIG. 27 illustrates an exemplary database for a patient in anotherembodiment of the present invention;

FIG. 28 is a flowchart illustrating the procedure for identifying adentition profile using the indexing system in accordance with oneembodiment of the present invention;

FIG. 29 is a flowchart illustrating the overall procedure for dynamicorthodontic treatment management in accordance with one embodiment ofthe present invention;

FIG. 30 is a flowchart illustrating dynamic treatment planning procedurein accordance with one embodiment of the present invention;

FIG. 31 is a flowchart illustrating dynamic treatment planning procedurein accordance with another embodiment of the present invention;

FIG. 32 is a flowchart illustrating dynamic treatment planning procedurein accordance with yet another embodiment of the present invention;

FIG. 33 is a flowchart illustrating dynamic treatment planning procedurein accordance with still another embodiment of the present invention;

FIG. 34 is a flowchart illustrating dynamic treatment profile assessmentin accordance with one embodiment of the present invention;

FIG. 35 is a flowchart illustrating importance assessment of FIG. 34 inaccordance with one embodiment of the present invention;

FIG. 36 is a flowchart illustrating dynamic treatment profile assessmentin accordance with another embodiment of the present invention;

FIG. 37 is a flowchart illustrating dynamically weighted treatmentplanning assessment in accordance with one embodiment of the presentinvention;

FIG. 38 is a flowchart illustrating dynamically weighted treatmentplanning assessment in accordance with another embodiment of the presentinvention;

FIG. 39 is a flowchart illustrating a predefined template manipulationin the overall procedure for dynamic orthodontic treatment management inaccordance with one embodiment of the present invention; and

FIG. 40 is a flowchart illustrating a predefined template manipulationin the overall procedure for dynamic orthodontic treatment management inaccordance with another embodiment of the present invention.

DETAILED DESCRIPTION

Digital treatment plans are now possible with 3-dimensional orthodontictreatment planning tools such as ClinCheck®. from Align Technology, Inc.or other software available from eModels and OrthoCAD, among others.These technologies allow the clinician to use the actual patient'sdentition as a starting point for customizing the treatment plan. TheClinCheck®. technology uses a patient-specific digital model to plot atreatment plan, and then use a scan of the achieved treatment outcome toassess the degree of success of the outcome as compared to the originaldigital treatment plan as discussed in U.S. patent application Ser. No.10/640,439, filed Aug. 21, 2003 and U.S. patent application Ser. No.10/225,889 filed Aug. 22, 2002. The problem with the digital treatmentplan and outcome assessment is the abundance of data and the lack ofstandards and efficient methodology by which to assess “treatmentsuccess” at an individual patient level. To analyze the information, adental data mining system is used.

FIG. 1A shows one exemplary dental data mining system. In this system,dental treatment and outcome data sets 1 are stored in a database orinformation warehouse 2. The data is extracted by data mining software 3that generates results 4. The data mining software can interrogate theinformation captured and/or updated in the database 2 and can generatean output data stream correlating a patient tooth problem with a dentalappliance solution. Note that the output of the data mining software canbe most advantageously, self-reflexively, fed as a subsequent input toat least the database and the data mining correlation algorithm.

The result of the data mining system of FIG. 1A is used for definingappliance configurations or changes to appliance configurations forincrementally moving teeth. The tooth movements will be those normallyassociated with orthodontic treatment, including translation in allthree orthogonal directions, rotation of the tooth centerline in the twoorthogonal directions with rotational axes perpendicular to a verticalcenterline (“root angulation” and “torque”), as well as rotation of thetooth centerline in the orthodontic direction with an axis parallel tothe vertical centerline (“pure rotation”).

In one embodiment, the data mining system captures the 3-D treatmentplanned movement, the start position and the final achieved dentalposition. The system compares the outcome to the plan, and the outcomecan be achieved using any treatment methodology including removableappliances as well as fixed appliances such as orthodontic brackets andwires, or even other dental treatment such as comparing achieved to planfor orthognathic surgery, periodontics, restorative, among others.

In one embodiment, a teeth superimposition tool is used to matchtreatment files of each arch scan. The refinement scan is superimposedover the initial one to arrive at a match based upon tooth anatomy andtooth coordinate system. After teeth in the two arches are matched, thesuperimposition tool asks for a reference in order to relate the upperarch to the lower arch. When the option “statistical filtering” isselected, the superimposition tool measures the amount of movement foreach tooth by first eliminating as reference the ones that move(determined by the difference in position between the current stage andthe previous one) more than one standard deviation either above or belowthe mean of movement of all teeth. The remaining teeth are then selectedas reference to measure movement of each tooth.

FIG. 1B shows an analysis of the performance of one or more dentalappliances. “Achieved” movement is plotted against “Goal” movement inscatter graphs, and trend lines are generated. Scatter graphs are shownto demonstrate where all “scattered” data points are, and trend linesare generated to show the performance of the dental appliances. In oneembodiment, trend lines are selected to be linear (they can becurvilinear); thus trend lines present as the “best fit” straight linesfor all “scattered” data. The performance of the Aligners is representedas the slope of a trend line. The Y axis intercept models the incidentalmovement that occurs when wearing the Aligners. Predictability ismeasured by R² that is obtained from a regression computation of“Achieved” and “Goal” data.

FIG. 1C shows various Movement Type data used in one embodiment of thedata mining system. Exemplary data sets cover Expansion/Constriction(+/−X Translation), Mesialization/Distalization (+/−Y Translation),Intrusion (−Z Translation), Extrusion (+Z Translation), Tip/Angulation(X Rotation), Torque/Inclination (Y Rotation), and Pure Rotation (ZRotation).

FIG. 1D shows an analysis of the performance of one or more dentalappliances. For the type of motion illustrated by FIG. 1D, the motionachieved is about 85% of targeted motion for that particular set ofdata.

As illustrated saliently in FIG. 1D, actual tooth movement generallylags targeted tooth movement at many stages. In the case of treatmentwith sequences of polymer appliances, such lags play an important rolein treatment design, because both tooth movement and such negativeoutcomes as patient discomfort vary positively with the extent of thediscrepancies.

In one embodiment, clinical parameters in steps such as 170 (FIG. 2A)and 232 (FIG. 2B) are made more precise by allowing for the statisticaldeviation of targeted from actual tooth position. For example, asubsequent movement target might be reduced because of a largecalculated probability of currently targeted tooth movement not havingbeen achieved adequately, with the result that there is a highprobability the subsequent movement stage will need to complete workintended for an earlier stage. Similarly, targeted movement mightovershoot desired positions especially in earlier stages so thatexpected actual movement is better controlled. This embodimentsacrifices the goal of minimizing round trip time in favor of achievinga higher probability of targeted end-stage outcome. This methodology isaccomplished within treatment plans specific to clusters of similarpatient cases.

Table 1 shows grouping of teeth in one embodiment. The sign conventionof tooth movements is indicated in Table 2. Different tooth movements ofthe selected 60 arches were demonstrated in Table 3 with performancesorted by descending order. The appliance performance can be broken into4 separate groups: high (79-85%), average (60-68%), below average(52-55%), and inadequate (24-47%). Table 4 shows ranking of movementpredictability. Predictability is broken into 3 groups: highlypredictable (0.76-0.82), predictable (0.43-0.63) and unpredictable(0.10-0.30). For the particular set of data, for example, the findingsare as follows:

1. Incisor intrusion, and anterior intrusion performance are high. Therange for incisor intrusion is about 1.7 mm, and for anterior intrusionis about 1.7 mm. These movements are highly predictable.

2. Canine intrusion, incisor torque, incisor rotation and anteriortorque performance are average. The range for canine intrusion is about1.3 mm, for incisor torque is about 34 degrees, for incisor rotation isabout 69 degrees, and for anterior torque is about 34 degrees. Thesemovements are either predictable or highly predictable.

3. Bicuspid tipping, bicuspid mesialization, molar rotation, andposterior expansion performance are below average. The range forbicuspid mesialization is about 1 millimeter, for bicuspid tipping isabout 19 degrees, for molar rotation is about 27 degrees and forposterior expansion is about 2.8 millimeters. Bicuspid tipping andmesialization are unpredictable, whereas the rest are predictablemovements.

4. Anterior and incisor extrusion, round teeth and bicuspid rotation,canine tipping, molar distalization, and posterior torque performanceare inadequate. The range of anterior extrusion is about 1.7millimeters, for incisor extrusion is about 1.5 mm, for round teethrotation is about 67 degrees, for bicuspid rotation is about 63 degrees,for canine tipping is about 26 degrees, for molar distalization is about2 millimeters, and for posterior torque is about 43 degrees. All areunpredictable movements except bicuspid rotation which is predictable.TABLE 1 Studied groups of teeth Teeth Incisors #7, 8, 9, 10, 23, 24, 25,26 Canines #6, 11, 22, 27 Bicuspids #4, 5, 12, 13, 20, 21, 28, 29 Molars#2, 3, 14, 15, 18, 19, 30, 31 Anteriors #6, 7, 8, 9, 10, 11, 22, 23, 24,25, 26, 27 Posteriors #2, 3, 4, 5, 12, 13, 14, 15, 18, 19, 20, 21, 28,29, 30, 31 Round #4, 5, 6, 11, 12, 13, 20, 21, 22, 27, 28, 29

TABLE 2 Sign convention of tooth movements Type of Movement Xtranslation (−) is lingual (+) is buccal (Expansion/ Constriction) Xrotation (Tipping) Upper & Lower (−) is distal (+) is mesial rightquadrants Upper & Lower (−) is mesial (+) is distal left quadrants Ytranslation (Mesialization/Distalization) Upper left & Lower (−) isdistal (+) is mesial right quadrants Upper right & Lower (−) is mesial(+) is distal left quadrants Y rotation (−) is lingual (+) is buccalcrown (Torquing) crown Z translation (−) is intrusion (+) is extrusion(Intrusion/Extrusion) Z rotation (−) is clockwise (+) iscounterclockwise (Pure Rotation)

TABLE 3 Ranking of Performance Index of movement Performance SidePredict- Group Movement Model Index Effect ability Incisor IntrusionLinear 85% 0.03 0.82 Anterior Intrusion Linear 79% 0.03 0.76 CanineIntrusion Linear 68% −0.10 0.43 Incisor Torque Linear 67% 0.21 0.63Anterior Torque Linear 62% 0.15 0.56 Incisor Rotation Linear 61% −0.090.76 Bicuspid Tipping Linear 55% 0.35 0.27 Molar Rotation Linear 52%0.11 0.58 Posterior Expansion Linear 52% 0.11 0.48 BicuspidMesialization Linear 52% 0.00 0.30 Bicuspid Rotation Linear 47% 0.280.63 Molar Distalization Linear 43% 0.02 0.20 Canine Tipping Linear 42%0.10 0.28 Posterior Torque Linear 42% 1.50 0.28 Round Rotation Linear39% −0.14 0.27 Anterior Extrusion Linear 29% −0.02 0.13 IncisorExtrusion Linear 24% 0.02 0.10

TABLE 4 Ranking of movement predictability Performance Side Predict-Group Movement Model Index Effect ability Incisor Intrusion Linear 85%0.03 0.82 Anterior Intrusion Linear 79% 0.03 0.76 Incisor RotationLinear 61% −0.09 0.76 Incisor Torque Linear 67% 0.21 0.63 BicuspidRotation Linear 47% 0.28 0.63 Molar Rotation Linear 52% 0.11 0.58Anterior Torque Linear 62% 0.15 0.56 Posterior Expansion Linear 52% 0.110.48 Canine Intrusion Linear 68% −0.10 0.43 Bicuspid MesializationLinear 52% 0.00 0.30 Canine Tipping Linear 42% 0.10 0.28 PosteriorTorque Linear 42% 1.50 0.28 Bicuspid Tipping Linear 55% 0.35 0.27 RoundRotation Linear 39% −0.14 0.27 Molar Distalization Linear 43% 0.02 0.20Anterior Extrusion Linear 29% −0.02 0.13 Incisor Extrusion Linear 24%0.02 0.10

In one embodiment, data driven analyzers may be applied. These datadriven analyzers may incorporate a number of models such as parametricstatistical models, non-parametric statistical models, clusteringmodels, nearest neighbor models, regression methods, and engineered(artificial) neural networks. Prior to operation, data driven analyzersor models are built using one or more training sessions. The data usedto build the analyzer or model in these sessions are typically referredto as training data. As data driven analyzers are developed by examiningonly training examples, the selection of the training data cansignificantly affect the accuracy and the learning speed of the datadriven analyzer. One approach used heretofore generates a separate dataset referred to as a test set for training purposes. The test set isused to avoid overfitting the model or analyzer to the training data.Overfitting refers to the situation where the analyzer has memorized thetraining data so well that it fails to fit or categorize unseen data.Typically, during the construction of the analyzer or model, theanalyzer's performance is tested against the test set. The selection ofthe analyzer or model parameters is performed iteratively until theperformance of the analyzer in classifying the test set reaches anoptimal point. At this point, the training process is completed. Analternative to using an independent training and test set is to use amethodology called cross-validation. Cross-validation can be used todetermine parameter values for a parametric analyzer or model for anon-parametric analyzer. In cross-validation, a single training data setis selected. Next, a number of different analyzers or models are builtby presenting different parts of the training data as test sets to theanalyzers in an iterative process. The parameter or model structure isthen determined on the basis of the combined performance of all modelsor analyzers. Under the cross-validation approach, the analyzer or modelis typically retrained with data using the determined optimal modelstructure.

In one embodiment, the data mining software 3 (FIG. 1A) can be a“spider” or “crawler” to grab data on the database 2 (FIG. 1A) forindexing. In one embodiment, clustering operations are performed todetect patterns in the data. In another embodiment, a neural network isused to recognize each pattern as the neural network is quite robust atrecognizing dental treatment patterns. Once the treatment features havebeen characterized, the neural network then compares the input dentalinformation with stored templates of treatment vocabulary known by theneural network recognizer, among others. The recognition models caninclude a Hidden Markov Model (HMM), a dynamic programming model, aneural network, a fuzzy logic, or a template matcher, among others.These models may be used singly or in combination.

Dynamic programming considers all possible paths of M “frames” through Npoints, subject to specified costs for making transitions from any pointi to any given frame k to any point j at the next frame k+1. Because thebest path from the current point to the next point is independent ofwhat happens beyond that point, the minimum total cost [i(k), j(k+1)] ofa path through i(k) ending at j(k+1) is the cost of the transitionitself plus the cost of the minimum path to i(k). Preferably, the valuesof the predecessor paths can be kept in an M×N array, and theaccumulated cost kept in a 2×N array to contain the accumulated costs ofthe possible immediately preceding column and the current column.However, this method requires significant computing resources.

Dynamic programming requires a tremendous amount of computation. For therecognizer to find the optimal time alignment between a sequence offrames and a sequence of node models, it must compare most framesagainst a plurality of node models. One method of reducing the amount ofcomputation required for dynamic programming is to use pruning. Pruningterminates the dynamic programming of a given portion of dentaltreatment information against a given treatment model if the partialprobability score for that comparison drops below a given threshold.This greatly reduces computation.

Considered to be a generalization of dynamic programming, a hiddenMarkov model is used in the preferred embodiment to evaluate theprobability of occurrence of a sequence of observations O(1), O(2),O(t), . . . , O(T), where each observation O(t) may be either a discretesymbol under the VQ approach or a continuous vector. The sequence ofobservations may be modeled as a probabilistic function of an underlyingMarkov chain having state transitions that are not directly observable.

In the preferred embodiment, the Markov model is used to modelprobabilities for sequences of treatment observations. The transitionsbetween states are represented by a transition matrix A=[a(i,j)]. Eacha(i,j) term of the transition matrix is the probability of making atransition to state j given that the model is in state i. The outputsymbol probability of the model is represented by a set of functionsB=[b(j), where the b(j) term of the output symbol matrix is the functionthat when evaluated on a specified value O(t) returns the probability ofoutputting observation O(t), given that the model is in state j. Thefirst state is always constrained to be the initial state for the firsttime frame of the Markov chain, only a prescribed set of left to rightstate transitions are possible. A predetermined final state is definedfrom which transitions to other states cannot occur.

In one embodiment, transitions are restricted to reentry of a state orentry to one of the next two states. Such transitions are defined in themodel as transition probabilities. For example, a treatment patterncurrently having a frame of feature signals in state 2 has a probabilityof reentering state 2 of a(2,2), a probability a(2,3) of entering state3 and a probability of a(2,4)=1−a(2,2)−a(2,3) of entering state 4. Theprobability a(2,1) of entering state 1 or the probability a(2,5) ofentering state 5 is zero and the sum of the probabilities a(2,1) througha(2,5) is one. Although the preferred embodiment restricts the flowgraphs to the present state or to the next two states, one skilled inthe art can build an HMM model with more flexible transitionrestrictions, although the sum of all the probabilities of transitioningfrom any state must still add up to one.

In each state j of the model, the current feature frame may beidentified with one of a set of predefined output symbols or may belabeled probabilistically. In this case, the output symbol probabilityb(j) (O(t)) corresponds to the probability assigned by the model thatthe feature frame symbol is O(t). The model arrangement is a matrixA=[a(i,j)] of transition probabilities and a technique of computingB=[b(j) (O(t))].

In one embodiment, the Markov model is formed for a reference patternfrom a plurality of sequences of training patterns and the output symbolprobabilities are multivariate Gaussian function probability densities.The dental treatment information traverses through the featureextractor. During learning, the resulting feature vector series isprocessed by a parameter estimator, whose output is provided to thehidden Markov model. The hidden Markov model is used to derive a set ofreference pattern templates, each template representative of anidentified pattern in a vocabulary set of reference treatment patterns.The Markov model reference templates are next utilized to classify asequence of observations into one of the reference patterns based on theprobability of generating the observations from each Markov modelreference pattern template. During recognition, the unknown pattern canthen be identified as the reference pattern with the highest probabilityin the likelihood calculator.

The HMM template has a number of states, each having a discrete value.However, as treatment pattern features may have a dynamic pattern incontrast to a single value, the addition of a neural network at thefront end of the HMM in an embodiment provides the capability ofrepresenting states with dynamic values. The input layer of the neuralnetwork comprises input neurons. The outputs of the input layer aredistributed to all neurons in the middle layer. Similarly, the outputsof the middle layer are distributed to all output neurons, which outputneurons correspond one-to one with internal states of the HMM. However,each output has transition probabilities to itself or to other outputs,thus forming a modified HMM. Each state of the thus formed HMM iscapable of responding to a particular dynamic signal, resulting in amore robust HMM. Alternatively, the neural network can be used alonewithout resorting to the transition probabilities of the HMMarchitecture.

The output streams or results 4 of FIG. 1A are used as feedback inimproving dental appliance design and/or usage by doctors. For example,the data mining results can be used to evaluate performance based onstaging approaches, to compare appliance performance indices based ontreatment approaches, and to evaluate performance comparing differentattachment shapes and positions on teeth.

The ability to study tooth-specific efficacy and product performance forlarge clusters of treatment outcomes enables statistically significantcomparisons to be made between two or more populations of cases. In theevent that the two clusters studied contain differences in treatmentapproach, appliance design, or manufacturing protocol, the differencesseen in the performance of the product as exhibited by the data output,can be attributed to the approach, design, or manufacturing protocol.The end result is a feedback mechanism that enables either the clinicianor the manufacturer the ability to optimize the product design and usagebased on performance data from a significantly large sample size usingobjective measurable data.

The theory of orthodontic treatment is not universally agreed upon, andactual treatment and outcomes are subject to additional uncertainties ofmeasurement of patient variables, of relationships to unmeasured patientvariables, as well as of varying patient compliance. As a result,different clinicians might prefer different treatment plans for a singlepatient. Thus, a single treatment plan may not be accepted by everyclinician since there is no universally accepted “correct” treatmentplan.

The next few embodiments allow greater clinician satisfaction andgreater patient satisfaction by tailoring treatment parameters topreferences of clinicians. The system detects differences in treatmentpreferences by statistical observation of the treatment histories ofclinicians. For example, clinicians vary in how likely they would be toperform bicuspid extraction in cases with comparable crowding. Even whenthere is not a sufficient record of past treatments for a givenclinician, clustering may be performed on other predictor variables suchas geographical location, variables related to training, or size andnature of practice, to observe statistically significant differences intreatment parameters.

Data mining can discover statistically significant patterns of differenttreatment outcomes achieved by different clinicians for comparablepatients. For example, patient cases clustered together might havesystematically fewer complications with one clinician as compared toanother. Such a difference detected by the data mining tool might beused as a flag for feedback to the more poorly performing clinician aswell as a flag for solicitation of treatment differences used by thebetter performing clinician.

In one embodiment, clustering techniques are used with previouslycompleted cases to categorize treatment complications and outcomes.Probability models of risk are then built within each cluster. New casesare then allocated to the same clusters based on similarity ofpre-treatment variables. The risks within each cluster of patients withcompleted treatments are then used with new cases to predict treatmentoutcomes and risks of complications. High-risk patients are then flaggedfor special attention, possibly including additional steps in treatmentplan or additional clinical intervention.

In another embodiment, practitioners are clustered into groups byobserved clinician treatment preferences, and treatment parameters areadjusted within each group to coincide more closely with observedtreatment preferences. Practitioners without observed histories are thenassigned to groups based on similarity of known variables to thosewithin clusters with known treatment histories.

FIG. 1E shows an exemplary process for clusterizing practices. First,the process clusterizes treatment practice based on clinician treatmenthistory such as treatment preferences, outcomes, and demographic andpractice variables (20). Next, the system models preferred clinicalconstraints within each cluster (22). Next, the system assignsclinicians without treatment history to clusters in 20 based ondemographic and practice variables (24). In one embodiment, the systemperforms process 100 (see FIG. 2A) separately within each cluster, usingcluster-specific clinical constraints (26). Additionally, the systemupdates clusters and cluster assignments as new treatment and outcomedata arrives (28).

FIG. 1F shows another embodiment of a data mining system to generateproposed treatments. First, the system identifies/clusterizes patienthistories having detailed follow-up (such as multiple high-resolutionscans), based on detailed follow-up data, diagnosis, treatmentparameters and outcomes, and demographic variables (40). Within eachcluster, the system models discrepancies between intended position andactual positions obtained from follow-up data (42). Further, within eachcluster, the system models risk for special undesirable outcomes (44).At a second tier of clustering, patient histories with less detailedfollow-up data are clusterized based on available variables. Thesecond-tier clustering is partial enough that each of the larger numberof second tier clusters can either be assigned to clusters calculated in40 or else considered a new cluster (46). The system refines step 42models with additional records from step 46 clusters (48). It can alsorefine step 44 models with additional records from step 48 clusters(50). At a third tier of clustering, the system then assigns newpatients to step 46 clusters based on diagnosis, demographic, andinitial physical (52). Within each step 52 cluster, the system modelsexpected discrepancies between intended position and actual positions(54). From step 54, the system uses revised expected positioninformation where relevant (including 232 and 250, FIG. 2B) (67).Additionally, within each step 52 cluster, the system models risk forundesirable outcomes (56). From step 56, the system also flags casesthat require special attention and clinical constraints (as in 204 and160, FIGS. 2B and 2A) (69). The process then customizes treatment planto each step 52 cluster (58). Next, the system iteratively collects data(61) and loops back to identify/clusterize patient histories (40).Additionally, clusters can be revised and reassigned (63). The systemalso continually identifies clusters without good representation foradditional follow-up analysis (65).

In clinical treatment settings, it is not cost-effective to obtain orprocess the full high-resolution data possible at every stage of toothmovement. For example:

-   -   Patients may use several appliances between visits to        clinicians.    -   A given patient may submit only one set of tooth impressions.    -   Radiation concerns may limit the number of CT or X-Ray scans        used.    -   Clinicians generally do not have the time to report detailed        spatial information on each tooth at each visit.

Due to these and other limitations, treatment planning is necessarilymade based on partial information.

In one embodiment, missing information is approximated substantially bymatching predictive characteristics between patients and arepresentative sample for which detailed follow-up information iscollected. In this case, patients are flagged based on poorlyanticipated treatment outcomes for requests for follow-up information,such as collection and analysis of additional sets of tooth impressions.Resulting information is then used to refine patient clusters andtreatment of patients later assigned to the clusters.

In general, patient data is scanned and the data is analyzed using thedata mining system described above. A treatment plan is proposed by thesystem for the dental practitioner to approve. The dental practitionercan accept or request modifications to the treatment plan. Once thetreatment plan is approved, manufacturing of appliance(s) can begin.

FIG. 2A illustrates the general flow of an exemplary process 100 fordefining and generating repositioning appliances for orthodontictreatment of a patient. The process 100 includes the methods, and issuitable for the apparatus, of the present invention, as will bedescribed. The computational steps of the process are advantageouslyimplemented as computer program modules for execution on one or moreconventional digital computers.

As an initial step, a mold or a scan of patient's teeth or mouth tissueis acquired (110). This step generally involves taking casts of thepatient's teeth and gums, and may in addition or alternately involvetaking wax bites, direct contact scanning, x-ray imaging, tomographicimaging, sonographic imaging, and other techniques for obtaininginformation about the position and structure of the teeth, jaws, gumsand other orthodontically relevant tissue. From the data so obtained, adigital data set is derived that represents the initial (that is,pretreatment) arrangement of the patient's teeth and other tissues.

The initial digital data set, which may include both raw data fromscanning operations and data representing surface models derived fromthe raw data, is processed to segment the tissue constituents from eachother (step 120). In particular, in this step, data structures thatdigitally represent individual tooth crowns are produced.Advantageously, digital models of entire teeth are produced, includingmeasured or extrapolated hidden surfaces and root structures.

The desired final position of the teeth—that is, the desired andintended end result of orthodontic treatment—can be received from aclinician in the form of a prescription, can be calculated from basicorthodontic principles, or can be extrapolated computationally from aclinical prescription (step 130). With a specification of the desiredfinal positions of the teeth and a digital representation of the teeththemselves, the final position and surface geometry of each tooth can bespecified (step 140) to form a complete model of the teeth at thedesired end of treatment. Generally, in this step, the position of everytooth is specified. The result of this step is a set of digital datastructures that represents an orthodontically correct repositioning ofthe modeled teeth relative to presumed-stable tissue. The teeth andtissue are both represented as digital data.

Having both a beginning position and a final position for each tooth,the process next defines a tooth path for the motion of each tooth. Inone embodiment, the tooth paths are optimized in the aggregate so thatthe teeth are moved in the quickest fashion with the least amount ofround-tripping to bring the teeth from their initial positions to theirdesired final positions. (Round-tripping is any motion of a tooth in anydirection other than directly toward the desired final position.Round-tripping is sometimes necessary to allow teeth to move past eachother.) The tooth paths are segmented. The segments are calculated sothat each tooth's motion within a segment stays within threshold limitsof linear and rotational translation. In this way, the end points ofeach path segment can constitute a clinically viable repositioning, andthe aggregate of segment end points constitute a clinically viablesequence of tooth positions, so that moving from one point to the nextin the sequence does not result in a collision of teeth.

The threshold limits of linear and rotational translation areinitialized, in one implementation, with default values based on thenature of the appliance to be used. More individually tailored limitvalues can be calculated using patient-specific data. The limit valuescan also be updated based on the result of an appliance-calculation(step 170, described later), which may determine that at one or morepoints along one or more tooth paths, the forces that can be generatedby the appliance on the then-existing configuration of teeth and tissueis incapable of effecting the repositioning that is represented by oneor more tooth path segments. With this information, the subprocessdefining segmented paths (step 150) can recalculate the paths or theaffected subpaths.

At various stages of the process, and in particular after the segmentedpaths have been defined, the process can, and generally will, interactwith a clinician responsible for the treatment of the patient (step160). Clinician interaction can be implemented using a client processprogrammed to receive tooth positions and models, as well as pathinformation from a server computer or process in which other steps ofprocess 100 are implemented. The client process is advantageouslyprogrammed to allow the clinician to display an animation of thepositions and paths and to allow the clinician to reset the finalpositions of one or more of the teeth and to specify constraints to beapplied to the segmented paths. If the clinician makes any such changes,the subprocess of defining segmented paths (step 150) is performedagain.

The segmented tooth paths and associated tooth position data are used tocalculate clinically acceptable appliance configurations (or successivechanges in appliance configuration) that will move the teeth on thedefined treatment path in the steps specified by the path segments (step170). Each appliance configuration represents a step along the treatmentpath for the patient. The steps are defined and calculated so that eachdiscrete position can follow by straight-line tooth movement or simplerotation from the tooth positions achieved by the preceding discretestep and so that the amount of repositioning required at each stepinvolves an orthodontically optimal amount of force on the patient'sdentition. As with the path definition step, this appliance calculationstep can include interactions and even iterative interactions with theclinician (step 160). The operation of a process step 200 implementingthis step will be described more fully below.

Having calculated appliance definitions, the process 100 can proceed tothe manufacturing step (step 180) in which appliances defined by theprocess are manufactured, or electronic or printed information isproduced that can be used by a manual or automated process to defineappliance configurations or changes to appliance configurations.

FIG. 2B illustrates a process 200 implementing the appliance-calculationstep (FIG. 2A, step 170) for polymeric shell aligners of the kinddescribed in above-mentioned U.S. Pat. No. 5,975,893. Inputs to theprocess include an initial aligner shape 202, various control parameters204, and a desired end configuration for the teeth at the end of thecurrent treatment path segment 206. Other inputs include digital modelsof the teeth in position in the jaw, models of the jaw tissue, andspecifications of an initial aligner shape and of the aligner material.Using the input data, the process creates a finite element model of thealigner, teeth and tissue, with the aligner in place on the teeth (step210). Next, the process applies a finite element analysis to thecomposite finite element model of aligner, teeth and tissue (step 220).The analysis runs until an exit condition is reached, at which time theprocess evaluates whether the teeth have reached the desired endposition for the current path segment, or a position sufficiently closeto the desired end position (step 230). If an acceptable end position isnot reached by the teeth, the process calculates a new candidate alignershape (step 240). If an acceptable end position is reached, the motionsof the teeth calculated by the finite elements analysis are evaluated todetermine whether they are orthodontically acceptable (step 232). Ifthey are not, the process also proceeds to calculate a new candidatealigner shape (step 240). If the motions are orthodontically acceptableand the teeth have reached an acceptable position, the current alignershape is compared to the previously calculated aligner shapes. If thecurrent shape is the best solution so far (decision step 250), it issaved as the best candidate so far (step 260). If not, it is saved in anoptional step as a possible intermediate result (step 252). If thecurrent aligner shape is the best candidate so far, the processdetermines whether it is good enough to be accepted (decision step 270).If it is, the process exits. Otherwise, the process continues andcalculates another candidate shape (step 240) for analysis.

The finite element models can be created using computer programapplication software available from a variety of vendors. For creatingsolid geometry models, computer aided engineering (CAE) or computeraided design (CAD) programs can be used, such as the AutoCAD®. softwareproducts available from Autodesk, Inc., of San Rafael, Calif. Forcreating finite element models and analyzing them, program products froma number of vendors can be used, including the PolyFEM product availablefrom CADSI of Coralville, Iowa, the Pro/Mechanica simulation softwareavailable from Parametric Technology Corporation of Waltham, Mass., theI-DEAS design software products available from Structural DynamicsResearch Corporation (SDRC) of Cincinnati, Ohio, and the MSC/NASTRANproduct available from MacNeal-Schwendler Corporation of Los Angeles,Calif.

FIG. 3 shows a process 300 of creating a finite element model that canbe used to perform step 210 of the process 200 (FIG. 2). Input to themodel creation process 300 includes input data 302 describing the teethand tissues and input data 304 describing the aligner. The input datadescribing the teeth 302 include the digital models of the teeth;digital models of rigid tissue structures, if available; shape andviscosity specifications for a highly viscous fluid modeling thesubstrate tissue in which the teeth are embedded and to which the teethare connected, in the absence of specific models of those tissues; andboundary conditions specifying the immovable boundaries of the modelelements. In one implementation, the model elements include only modelsof the teeth, a model of a highly viscous embedding substrate fluid, andboundary conditions that define, in effect, a rigid container in whichthe modeled fluid is held. Note that fluid characteristics may differ bypatient clusters, for example as a function of age.

A finite element model of the initial configuration of the teeth andtissue is created (step 310) and optionally cached for reuse in lateriterations of the process (step 320). As was done with the teeth andtissue, a finite element model is created of the polymeric shell aligner(step 330). The input data for this model includes data specifying thematerial of which the aligner is made and the shape of the aligner (datainput 304).

The model aligner is then computationally manipulated to place it overthe modeled teeth in the model jaw to create a composite model of anin-place aligner (step 340). Optionally, the forces required to deformthe aligner to fit over the teeth, including any hardware attached tothe teeth, are computed and used as a figure of merit in measuring theacceptability of the particular aligner configuration. Optionally, thetooth positions used are as estimated from a probabilistic model basedon prior treatment steps and other patient information. In a simpleralternative, however, the aligner deformation is modeled by applyingenough force to its insides to make it large enough to fit over theteeth, placing the model aligner over the model teeth in the compositemodel, setting the conditions of the model teeth and tissue to beinfinitely rigid, and allowing the model aligner to relax into positionover the fixed teeth. The surfaces of the aligner and the teeth aremodeled to interact without friction at this stage, so that the alignermodel achieves the correct initial configuration over the model teethbefore finite element analysis is begun to find a solution to thecomposite model and compute the movement of the teeth under theinfluence of the distorted aligner.

FIG. 4 shows a process 400 for calculating the shape of a next alignerthat can be used in the aligner calculations, step 240 of process 200(FIG. 2B). A variety of inputs are used to calculate the next candidatealigner shape. These include inputs 402 of data generated by the finiteelement analysis solution of the composite model and data 404 defined bythe current tooth path. The data 402 derived from the finite elementanalysis includes the amount of real elapsed time over which thesimulated repositioning of the teeth took place; the actual end toothpositions calculated by the analysis; the maximum linear and torsionalforce applied to each tooth; the maximum linear and angular velocity ofeach tooth. From the input path information, the input data 404 includesthe initial tooth positions for the current path segment, the desiredtooth positions at the end of the current path segment, the maximumallowable displacement velocity for each tooth, and the maximumallowable force of each kind for each tooth.

If a previously evaluated aligner was found to violate one or moreconstraints, additional input data 406 can optionally be used by theprocess 400. This data 406 can include information identifying theconstraints violated by, and any identified suboptimal performance of,the previously evaluated aligner. Additionally, input data 408 relatingto constraints violated by, and suboptimal performance of previousdental devices can be used by the process 400.

Having received the initial input data (step 420), the process iteratesover the movable teeth in the model. (Some of the teeth may beidentified as, and constrained to be, immobile.) If the end position anddynamics of motion of the currently selected tooth by the previouslyselected aligner is acceptable (“yes” branch of decision step 440), theprocess continues by selecting for consideration a next tooth (step 430)until all teeth have been considered (“done” branch from step 430 tostep 470). Otherwise (“no” branch from step 440), a change in thealigner is calculated in the region of the currently selected tooth(step 450). The process then moves back to select the next current tooth(step 430) as has been described.

When all of the teeth have been considered, the aggregate changes madeto the aligner are evaluated against previously defined constraints(step 470), examples of which have already been mentioned. Constraintscan be defined with reference to a variety of further considerations,such as manufacturability. For example, constraints can be defined toset a maximum or minimum thickness of the aligner material, or to set amaximum or minimum coverage of the aligner over the crowns of the teeth.If the aligner constraints are satisfied, the changes are applied todefine a new aligner shape (step 490). Otherwise, the changes to thealigner are revised to satisfy the constraints (step 480), and therevised changes are applied to define the new aligner shape (step 490).

FIG. 5A illustrates one implementation of the step of computing analigner change in a region of a current tooth (step 450). In thisimplementation, a rule-based inference engine 456 is used to process theinput data previously described (input 454) and a set of rules 452 a-452n in a rule base of rules 452. The inference engine 456 and the rules452 define a production system which, when applied to the factual inputdata, produces a set of output conclusions that specify the changes tobe made to the aligner in the region of the current tooth (output 458).

Rules 452 a . . . 452 n have the conventional two-part form: an if-partdefining a condition and a then-part defining a conclusion or actionthat is asserted if the condition is satisfied. Conditions can be simpleor they can be complex conjunctions or disjunctions of multipleassertions. An exemplary set of rules, which defines changes to be madeto the aligner, includes the following: if the motion of the tooth istoo fast, add driving material to the aligner opposite the desireddirection of motion; if the motion of the tooth is too slow, add drivingmaterial to overcorrect the position of the tooth; if the tooth is toofar short of the desired end position, add material to overcorrect; ifthe tooth has been moved too far past the desired end position, addmaterial to stiffen the aligner where the tooth moves to meet it; if amaximum amount of driving material has been added, add material toovercorrect the repositioning of the tooth and do not add drivingmaterial; if the motion of the tooth is in a direction other than thedesired direction, remove and add material so as to redirect the tooth.

In an alternative embodiment, illustrated in FIGS. 5B and 5C, anabsolute configuration of the aligner is computed, rather than anincremental difference. As shown in FIG. 5B, a process 460 computes anabsolute configuration for an aligner in a region of a current tooth.Using input data that has already been described, the process computesthe difference between the desired end position and the achieved endposition of the current tooth (462). Using the intersection of the toothcenter line with the level of the gum tissue as the point of reference,the process computes the complement of the difference in all six degreesof freedom of motion, namely three degrees of translation and threedegrees of rotation (step 464). Next, the model tooth is displaced fromits desired end position by the amounts of the complement differences(step 466), which is illustrated in FIG. 5B.

FIG. 5D shows a planar view of an illustrative model aligner 60 over anillustrative model tooth 62. The tooth is in its desired end positionand the aligner shape is defined by the tooth in this end position. Theactual motion of the tooth calculated by the finite element analysis isillustrated as placing the tooth in position 64 rather than in thedesired position 62. A complement of the computed end position isillustrated as position 66. The next step of process 460 (FIG. 5B)defines the aligner in the region of the current tooth in this iterationof the process by the position of the displaced model tooth (step 468)calculated in the preceding step (466). This computed alignerconfiguration in the region of the current tooth is illustrated in FIG.5D as shape 68 which is defined by the repositioned model tooth inposition 66.

A further step in process 460, which can also be implemented as a rule452 (FIG. 5A), is shown in FIG. 5C. To move the current tooth in thedirection of its central axis, the size of the model tooth defining thatregion of the aligner, or the amount of room allowed in the aligner forthe tooth, is made smaller in the area away from which the process hasdecided to move the tooth (step 465).

As shown in FIG. 6, the process 200 (FIG. 2B) of computing the shape foran aligner for a step in a treatment path is one step in a process 600of computing the shapes of a series of aligners. This process 600 beginswith an initialization step 602 in which initial data, control andconstraint values are obtained.

When an aligner configuration has been found for each step or segment ofthe treatment path (step 604), the process 600 determines whether all ofthe aligners are acceptable (step 606). If they are, the process iscomplete. Otherwise, the process optionally undertakes a set of steps610 in an attempt to calculate a set of acceptable aligners. First, oneor more of the constraints on the aligners is relaxed (step 612). Then,for each path segment with an unacceptable aligner, the process 200(FIG. 2B) of shaping an aligner is performed with the new constraints(step 614). If all the aligners are now acceptable, the process 600exits (step 616).

Aligners may be unacceptable for a variety of reasons, some of which arehandled by the process. For example, if any impossible movements wererequired (decision step 620), that is, if the shape calculation process200 (FIG. 2B) was required to effect a motion for which no rule oradjustment was available, the process 600 proceeds to execute a modulethat calculates the configuration of a hardware attachment to thesubject tooth to which forces can be applied to effect the requiredmotion (step 640). Because adding hardware can have an effect that ismore than local, when hardware is added to the model, the outer loop ofthe process 600 is executed again (step 642).

If no impossible movements were required (“no” branch from step 620),the process transfers control to a path definition process (such as step150, FIG. 2A) to redefine those parts of the treatment path havingunacceptable aligners (step 630). This step can include both changingthe increments of tooth motion, i.e., changing the segmentation, on thetreatment path, changing the path followed by one or more teeth in thetreatment path, or both. After the treatment path has been redefined,the outer loop of the process is executed again (step 632). Therecalculation is advantageously limited to recalculating only thosealigners on the redefined portions of the treatment path. If all thealigners are now acceptable, the process exits (step 634). Ifunacceptable aligners still remain, the process can be repeated until anacceptable set of aligners is found or an iteration limit is exceeded(step 650). At this point, as well as at other points in the processesthat are described in this specification, such as at the computation ofadditional hardware (step 640), the process can interact with a humanoperator, such as a clinician or technician, to request assistance (step652). Assistance that an operator provides can include defining orselecting suitable attachments to be attached to a tooth or a bone,defining an added elastic element to provide a needed force for one ormore segments of the treatment path, suggesting an alteration to thetreatment path, either in the motion path of a tooth or in thesegmentation of the treatment path, and approving a deviation from orrelaxation of an operative constraint.

As was mentioned above, the process 600 is defined and parameterized byvarious items of input data (step 602). In one implementation, thisinitializing and defining data includes the following items: aniteration limit for the outer loop of the overall process; specificationof figures of merit that are calculated to determine whether an aligneris good enough (see FIG. 2B, step 270); a specification of the alignermaterial; a specification of the constraints that the shape orconfiguration of an aligner must satisfy to be acceptable; aspecification of the forces and positioning motions and velocities thatare orthodontically acceptable; an initial treatment path, whichincludes the motion path for each tooth and a segmentation of thetreatment path into segments, each segment to be accomplished by onealigner; a specification of the shapes and positions of any anchorsinstalled on the teeth or otherwise; and a specification of a model forthe jaw bone and other tissues in or on which the teeth are situated (inthe implementation being described, this model consists of a model of aviscous substrate fluid in which the teeth are embedded and which hasboundary conditions that essentially define a container for the fluid).

FIG. 7 is an exemplary diagram of a statistical root model. As showntherein, using the scanning processes described above, a scanned upperportion 701 of a tooth is identified. The scanned upper portion,including the crown, is then supplemented with a modeled 3D root. The 3Dmodel of the root can be statistically modeled. The 3D model of the root702 and the 3D model of the upper portion 700 together form a complete3D model of a tooth.

FIG. 8 shows exemplary diagrams of root modeling, as enhanced usingadditional dental information. In FIG. 8, the additional dentalinformation is X-ray information. An X-ray image 710 of teeth is scannedto provide a 2D view of the complete tooth shapes. An outline of atarget tooth is identified in the X-Ray image. The model 712 asdeveloped in FIG. 7 is modified in accordance with the additionalinformation. In one embodiment, the tooth model of FIG. 7 is morphed toform a new model 714 that conforms with the X-ray data.

FIG. 9 shows an exemplary diagram of a CT scan of teeth. In thisembodiment, the roots are derived directly from a high-resolution CBCTscan of the patient. Scanned roots can then be applied to crowns derivedfrom an impression, or used with the existing crowns extracted from ConeBeam Computed Tomography (CBCT) data. A CBCT single scan gives 3D dataand multiple forms of X-ray-like data. PVS impressions are avoided.

In one embodiment, a cone beam x-ray source and a 2D area detector scansthe patient's dental anatomy, preferably over a 360 degree angular rangeand along its entire length, by any one of various methods wherein theposition of the area detector is fixed relative to the source, andrelative rotational and translational movement between the source andobject provides the scanning (irradiation of the object by radiationenergy). As a result of the relative movement of the cone beam source toa plurality of source positions (i.e., “views”) along the scan path, thedetector acquires a corresponding plurality of sequential sets of conebeam projection data (also referred to herein as cone beam data orprojection data), each set of cone beam data being representative ofx-ray attenuation caused by the object at a respective one of the sourcepositions.

FIG. 10 shows an exemplary user interface showing the erupted teeth,which can be shown with root information in another embodiment. Eachtooth is individually adjustable using a suitable handle. In theembodiment of FIG. 10, the handle allows an operator to move the toothin three-dimensions with six degrees of freedom.

The teeth movement is guided in part using a root-based sequencingsystem. In one embodiment, the movement is constrained by a surface areaconstraint, while in another embodiment, the movement is constrained bya volume constraint.

In one embodiment, the system determines a surface area for each toothmodel. The system then sums all surface areas for all tooth models to bemoved. Next, the system sums all surface areas of all tooth models onthe arch. For each stage of teeth movement, the system checks that apredetermined area ratio or constraint is met while the tooth models aremoved. In one implementation, the constraint can be to ensure that thesurface areas of moving teeth are less than the total surface areas ofteeth on an arch supporting the teeth being moved. If the ratio isgreater than a particular number such as 50%, the system indicates anerror signal to an operator to indicate that the teeth should be movedon a slower basis.

In another embodiment, the system determines the volume for each toothmodel. The system then sums the volumes for all tooth models beingmoved. Next, the system determines the total volume of all tooth modelson the arch. For each stage of teeth movement, the system checks that apredetermined volume ratio or constraint is met while the tooth modelsare moved. In one implementation, the constraint can be to ensure thatthe volume for moving teeth is less than the volume of all teeth on anarch supporting the teeth being moved. If the ratio is greater than aparticular number such as 50%, the system indicates an error signal toan operator to indicate that the teeth should be moved on a slowerbasis.

Optionally, other features are added to the tooth model data sets toproduce desired features in the aligners. For example, it may bedesirable to add digital wax patches to define cavities or recesses tomaintain a space between the aligner and particular regions of the teethor jaw. It may also be desirable to add digital wax patches to definecorrugated or other structural forms to create regions having particularstiffness or other structural properties. In manufacturing processesthat rely on generation of positive models to produce the repositioningappliance, adding a wax patch to the digital model will generate apositive mold that has the same added wax patch geometry. This can bedone globally in defining the base shape of the aligners or in thecalculation of particular aligner shapes. One feature that can be addedis a rim around the gumline, which can be produced by adding a digitalmodel wire at the gumline of the digital model teeth from which thealigner is manufactured. When an aligner is manufactured by pressurefitting polymeric material over a positive physical model of the digitalteeth, the wire along the gumlines causes the aligner to have a rimaround it providing additional stiffness along the gumline.

In another optional manufacturing technique, two sheets of material arepressure fit over the positive tooth model, where one of the sheets iscut along the apex arch of the aligner and the other is overlaid on top.This provides a double thickness of aligner material along the verticalwalls of the teeth.

The changes that can be made to the design of an aligner are constrainedby the manufacturing technique that will be used to produce it. Forexample, if the aligner will be made by pressure fitting a polymericsheet over a positive model, the thickness of the aligner is determinedby the thickness of the sheet. As a consequence, the system willgenerally adjust the performance of the aligner by changing theorientation of the model teeth, the sizes of parts of the model teeth,the position and selection of attachments, and the addition or removalof material (e.g., adding wires or creating dimples) to change thestructure of the aligner. The system can optionally adjust the alignerby specifying that one or more of the aligners are to be made of a sheetof a thickness other than the standard one, to provide more or lessforce to the teeth. On the other hand, if the aligner will be made by astereo lithography process, the thickness of the aligner can be variedlocally, and structural features such as rims, dimples, and corrugationscan be added without modifying the digital model of the teeth.

The system can also be used to model the effects of more traditionalappliances such as retainers and braces and therefore be used togenerate optimal designs and treatment programs for particular patients.

FIG. 11 is a block diagram of the overall indexing system 1100 forpracticing the various embodiments of the present invention. Theindexing system 1100 in one embodiment includes a terminal 1101, whichmay be configured as a personal computer, workstation, or mainframe, andwhich includes a user interface input device 1103 and a user interfaceoutput device 1105, a storage unit 1107, and a central server 1109.

Referring to FIG. 11, the user interface input device 1103 may include akeyboard and may further include a pointing devices and/or a scanner,including x-ray or intra-oral scanner. The pointing device may be anindirect pointing device such as a mouse, trackball, touchpad, orgraphics tablet, or a direct pointing device such as a touchscreenincorporated into the user interface output device 1105. Other types ofuser interface input devices, such as voice recognition systems, may beused within the scope of the present invention.

Referring again to FIG. 11, the user interface output device 1105 mayinclude a printer and a display subsystem, which includes a displaycontroller and a display device coupled to the controller. The displaydevice may be a cathode ray tube (CRT), a flat-panel device such as aliquid crystal display, or a projection device. The display subsystemmay also provide nonvisual display such as audio output.

The indexing system 1100 shown in FIG. 11 also includes the data storageunit 1107 which is configured to, under the access and control of eithera central server 1109 or a client application, to maintain the basicprogramming and data constructs that provide the functionality of thepresent invention. Software is stored in storage unit 1107 which mayinclude a memory unit and file storage unit. The memory unit may includea main random access memory (RAM) for storage of instructions and dataduring program execution and a read-only memory (ROM) in which fixedinstructions are stored.

The file storage unit of the data storage unit 1107 may providepersistent (nonvolatile) storage for program and data files, andtypically includes at least one hard disk drive and at least one CD-ROMdrive (with associated removable media). There may also be other devicessuch as a floppy disk drive and optical drives (all with theirassociated removable media). Additionally, the file storage unit mayinclude drives of the type with removable media cartridges, such as harddisk cartridges and flexible disk cartridges. One or more of the drivesmay be located at a remote location, such as in central server 1109 on alocal area network or at a site on the Internet's World Wide Web or theentire system may be a stand-alone software application resident on theuser's system.

In one aspect of the present invention, the central server 1109 may beconfigured to communicate with the terminal 1101 and data storage unit1107 to access software stored in the data storage unit 1107 based onand in response to the input received from terminal 1101, and to performadditional processing based on procedures and/or routines in accordancewith the instructions or input information received from the terminal1101.

Referring back to FIG. 11, the indexing system 1100 in accordance withone embodiment of the present invention organizes orthodontic needs bythe most common configurations of orthodontic discrepancies in thedifferent dimensions: sagittal, vertical, horizontal/transverse, andarch length. The categories may be expanded to specifically captureother components such as facial profile, individual dentalconfigurations, dynamic functional relationships, and surrounding softtissue conditions; however, discrepancies in these four categoriescapture a significant portion of orthodontic related dental problems orconcerns. Within each category, there may be a predetermined number ofindividual components to characterize the potential conditions for thatdimension. For each condition, a predetermined combination of differentpossible conditions may be created. This collection of predefinedcombinations for each component, where each component belongs to one ofthe four main categories described, in one embodiment defines a matrixsuch that any patient at any time point may be defined as a specificaddress within the matrix. Both the matrix and address matrix may bestored in storage unit 1107.

FIG. 12 illustrates an exemplary tabular representation of the indexingsystem matrix stored in the storage unit 1107 of FIG. 11 in accordancewith one embodiment of the present invention. The exemplary table 1200of FIG. 12 illustrates a simplified version of the possible conditionsfor one component within each of the four categories.

Referring to FIG. 12, the table 1200 includes a category field 1201, areference component field 1202, and the pre-defined options field 1203.Table 1200 also includes a number of options field 1204. The categoryfield 1201 in one embodiment includes the categories for which referencedentition condition information is stored. In the exemplary embodiment,the categories may include: sagittal, vertical, horizontal, and archlength. In this exemplary embodiment, the reference component field 1202includes one common component within each dimension by whichmalocclusion is judged. The common pre-defined options field 1203includes the various levels of malocclusion for that dimension of thecategory. For example, the common malocclusions for the right caninecomponent of the sagittal category are: Full class 2+(greater than fullcusp Class 2), Full (Cusp) Class 2, Partial Class 2 (also called end-onClass 2), and so on. Within each dimensional component selection is alsoa selection for “normal.”

Referring to FIG. 12, the number of options field 1204 in one embodimentincludes the number of possible reference conditions in each category,and also a total number of possible combinations of referenceconditions. For example, the sagittal category has seven (7) possiblereference conditions for the canine relationship component and thevertical category has seven (7) reference conditions for the anterioroverbite component. The example shown yields 7×7×7×7=2401 possiblecombinations of reference conditions for the four components, as shownin table 1200 of FIG. 12. In one embodiment, each of these 2,401 patientcase combinations is stored in a database in storage unit 1107 (FIG.11), for example, by the central server 1109. Since there can benumerous components used to describe each of the four main orthodonticdimensions and not just one component per dimension as illustrated, inpractice, the total number of combinations that can be used to describea patient may be substantially higher, but at the same time, will be afinite number such that it may be indexed, catalogued, and queried asdescribed in FIG. 11.

In reference to the index table 1200 illustrated in FIG. 12, anidentifier may be composed of a four-position, or “four-bit” matrix:ABCD. In this four-bit matrix, in one embodiment of the presentinvention, the “A” position in the matrix corresponds to the sagittaldimension, the “B” position in the matrix corresponds to the verticaldimension, the “C” position in the matrix corresponds to the horizontaldimension, and the “D” position in the matrix corresponds to the archlength dimension.

The actual number or letter in the position of each “bit” of the matrixmay be associated with the corresponding condition within the category.For example, referring again to the exemplary table 1200 of FIG. 12, anidentifier of 3256 represents: a right canine partial Class 2, withmoderate anterior deep bite, upper midline to the left 0-1 mm, and lowermoderate crowding. This “3256” identifier corresponds to an address inan indexing database stored in storage unit 1107 which has stored in thedatabase, related clinical information for the particular pairing of“3256” to a user-defined treatment goal (for example, discussed infurther detail below with reference to FIG. 14).

Dental Characterization Database

Referring back to FIG. 11, the indexing system 1100 in one embodiment ofthe present invention may also be used to represent one or more teethwithin a patient's dentition. Typically an adult patient's dentitionincludes 32 teeth. Dentists usually characterize five surfaces of eachtooth: mesial, occlusal/incisal, distal, buccal/facial, and lingual.Each of these surfaces may be natural or covered by a restoration suchas silver amalgam, composite, porcelain, gold, or metal crown. The toothmay also be missing or have been treated with a root canal or animplant. These combinations may be represented with an indexing systemfor the initial dentition, target dentition (treatment goal), and finaldentition which is the outcome of the treatment.

For each tooth in a patient's dentition, there may be a number ofpossible conditions based on the characteristics of the tooth, such asthe surface of the tooth and whether the tooth as been treated or ismissing. The combinations of different possible conditions of the teethdefine a matrix. An exemplary embodiment of the present inventionincludes a 32-position address within the matrix, where each position inthe address corresponds to a tooth in a patient's dentition and includesa sub-address in which alphanumeric characters or other representationsrepresent the current condition of the tooth.

A “5-bit” sub-address for each tooth includes positions 12345 where eachof the positions “1” to “5” represents one of the five surfaces of thetooth. In particular, position 1 of the sub-address corresponds to themesial surface of the tooth, position 2 of the sub-address correspondsto the occlusal or incisal surface of the tooth, position 3 of thesub-address corresponds to the distal surface of the tooth, position 4of the sub-address corresponds to buccal or facial surface of the tooth,and position 5 of the sub-address corresponds to the lingual surface ofthe tooth.

Moreover, each of the following characters “A” to “N” corresponds to acondition of the particular surface of the tooth in the sub-address. A =amalgam B = composite C = porcelain veneer D = gold E = porcelain crownF = gold crown G = gold crown with root canal H = porcelain crown withroot canal I = amalgam with root canal J = composite with root canal K =gold crown with implant L = porcelain crown with implant M = missing N =natural

For example, consider the following patient identifier 1:NNABN. Theidentifier 1:NNABN would represent: tooth number 1 of a 32-bit addresswhich has a natural mesial surface (subaddress position 1), an occlusalamalgam (subaddress position 2), a natural distal surface (subaddressposition 3), a buccal/facial composite (subaddress position 4), and anatural lingual surface (subaddress position 5).

In an exemplary embodiment of patient's initial dentition, targetdentition (treatment goal), and final dentition, such example may beconfigured as:TotalAddress=SubAddress1:SubAddress2:SubAddress3

SubAddress1=Teeth 1-32 initial

SubAddress2=Teeth 1-32 target

SubAddress3=Teeth 1-32 current, timepoint today

whereby each of the of the 1-32 may further include an additionsub-matrix of 1-5 surfaces as previously described.

In this manner, dentists may easily query their practice database todetermine how much dental work has been done and remains to be done.They can also track trends of use in their practice and what are themost common procedures in the practice. The patient matrix may also beused in forensics for patient identification purposes, as well as fornational security and other security purposes.

FIG. 13 illustrates an exemplary tabulation of the possible treatmentgoals of the indexing system treatment goal matrix stored in the storageunit 1107 of FIG. 11 in accordance with one embodiment of the presentinvention. Four examples of treatment goals are the following:

Treatment Goal 1: Pre-restorative set-up—the objective of this goal isto better position specific teeth for the purpose of improved placementof dental restorations such as crowns, bridges, and implants. Some ofthe patient's dental components may be left as is (untreated) if they donot contribute to the purpose of improvement of the restorative goal.

Treatment Goal 2: Esthetic alignment—the objective of this goal is toalign the patient's anterior teeth for the purpose of improvedesthetics. Generally speaking, the patient's bite may be left as is(untreated) if it does not contribute to the purpose of improving theesthetic component of the patient's smile.

Treatment Goal 3: Anterior function improvement—the objective of thisgoal is to improve the anterior function of the teeth while alsoimproving the anterior esthetic component. Generally speaking, thepatient's posterior occlusion may be left as is if it does notcontribute to the improvement of the canine function and/or anterioresthetics.

Treatment Goal 4: Optimal set-up—the objective of this goal is to makethe entire bite close to “textbook” ideal, including both the canine andmolar function.

FIG. 14 illustrates an expanded version of FIG. 13 using thecharacteristics as defined by the tabulation shown in FIG. 12. Morespecifically, each of the four treatment goals identified in FIG. 13 maybe further refined and formatted according to the tabulation andindexing shown in FIG. 12 to describe the target objective of treatmentin greater detail according to each individual component.

For example, for the treatment goal 1 for pre-restorative set-up, anexample of this goal according to the 4-bit matrix format in FIG. 12 maybe XXX4 where the “X” is the patient's existing relationship for thatcomponent left untreated, and only the fourth digit is planned fortreatment. Furthermore, for the treatment goal 2 for esthetic alignment,an example of this goal according to the 4-bit matrix format in FIG. 2may be XX44 where “X” is the patient's existing relationship for thatcomponent left untreated, and only the third and fourth digits(representing the transverse and arch length components, respectively)are planned for treatment.

In addition, for treatment goal 3 for anterior function improvement, anexample of this goal according to the 4-bit matrix format in FIG. 12 maybe 4×44 whereby “X” is the patient's existing relationship for thatcomponent left untreated. In this example, only the second digitcomponent (corresponding to the vertical dimension) is not planned fortreatment. Finally, for treatment goal 4 for optimal set-up, an exampleof this goal according to the 4-bit matrix defined in FIG. 12, may be4444.

There are various ways to generate an identifier which represents apatient's unique problem or case type. Traditionally, the method hasbeen to describe and define a characteristic and have the trainedindividual subjectively identify the condition or “label” which bestrepresents the patient's condition. To reduce the variability in thismethod requires calibration and/or objective measures to define each ofthe labels.

Another method involves using a visual image-based interface. Tocharacterize a patient's dentition, a user compares the patient'sdentition to images of reference dentition conditions which depict theseverity of malocclusion, or lack thereof. The user then identifieswhere the patient's dentition condition falls within a range ofreference conditions depicting malocclusion and selects the image thateither best represents the patient, or selects a relative position ofthe patient's condition from a continuous gradient of patient imagedepictions of the specific problem. The visual image interface can bepresented to the user without any descriptions or labels to avoid anypre-conceived biases associated with the label.

Visual images have been previously described in the ICON indexing systemfor example, to describe an esthetic component of the patient. In theICON system, the assessor selects 1 of 10 images which best representsthe patient's anterior esthetic component. Through calibration, multipleusers are then able to determine a patient's esthetic component withreasonable consistency. The use of a visual interface to capture everycomponent of the patient's orthodontic dental condition however, has notpreviously been described as an interface for creation of a digitalpatient database.

FIG. 15 illustrates the lower arch length component 1500 for use in theindexing system in accordance with one embodiment of the presentinvention. This illustration of the lower arch length component 1500 isan exemplary visual scale allowing the user to select an image which issimilar to the patient's dentition condition. Referring to FIG. 5, thereare shown seven images of the lower arch, each representing a possiblereference condition for the lower arch length category. In thisexemplary embodiment, images 1501-1507 represents the 7 imagescorresponding to the individual fields for the “Lower Arch Length”component of “Arch Length” dimension of FIG. 12. The user simply selectswhich of the seven images is best represented in the patient. Or theymay be able to select where in between two adjacent images the patientcan be best described. They do not need to know what the technical labelor term is; they simply need to select an image or area between twoimages based on direct comparison of the existing condition to thepictures presented.

In the exemplary embodiment shown in FIG. 15, each of the seven images1501-1507 has a corresponding predefined alphanumeric character. Thus,when an image is selected, the associated predefined alphanumericcharacter is added to the identifier address of the patient. By labelingeach category with an alphanumeric character, the patient's dentitionmay be characterized through alphanumeric addressing. The output to theuser may explain the specific details of their selection in greaterdetail, including the technical description and treatment optionsassociated with such a condition. In an alternate embodiment, analphanumeric character may be generated when the user selects the areain between adjacent images, representing that the patient's conditionfalls in between the condition of the adjacent images selected. The userinterface may also be a combination of both direct selection of theimage as well as in-between selection of images.

Referring now to FIG. 16, an exemplary doctor and patient informationdisplay 1600 for the indexing system 1100 is illustrated in accordancewith one embodiment of the present invention. This display 600 includesinformation input by a user into fields 1601-1603 to identify a patient.In particular, a patient's name is input into field 1601, a patient'sgender is input into field 1602, and a patient's primary concern(s) isinput into field 1603. The preferred embodiment of field 1603 is acheck-box selection of pre-defined possible conditions which can then becatalogued according to the selections of the user. It will beappreciated that other patient information may be added. Once thepatient information has been entered, a user can select a predefinedinput command or button to move onto the next display, which isillustrated in FIG. 17.

Referring to FIG. 17, an exemplary selection process display 1700 isshown for the sagittal dimension (matrix address position “A” in FIG.12)—right buccal, right canine/cuspid component. A series of images ofreference dentition conditions 1701-1703 are displayed in conjunctionwith buttons 1704 allowing the images to be scrolled to the left orright. A user clicks the left or right arrow buttons 1704 to select theimage of the reference dentition condition that best reflects thepatient's current condition specifically at the location(s) indicated bythe focusing arrows indicated in 1702. In this exemplary embodiment, auser clicks the left or right arrow buttons to select the cuspid(canine) relationship that is similar to a patient's current occlusion.

Once the selection is made, the next button 1705 is pressed to move ontothe next screen. The exemplary selection process display 1700 alsoincludes buttons 1706-1709 to allow a user to go back, access aglossary, ask for advice, and save the information, respectively.

Referring to FIG. 18, an exemplary selection process display 1800 isshown for the sagittal category—left buccal, left cuspid component. Aseries of images of reference dentition conditions 1801-1803 aredisplayed in association with buttons 804 allowing the images to bescrolled to the left or right. A user clicks the left or right arrowbuttons 804 to select the image of the reference dentition conditionthat best reflects the patient's current condition. In this exemplaryembodiment, a user clicks the left or right arrow buttons to select thecuspid relationship that is similar to a patient's current occlusion.

Once the selection is made, the next button 1805 is pressed to move ontothe next display which is illustrated in FIG. 19. The exemplaryselection process display 1800 also includes buttons 1806-1809 to allowa user to go back, access a glossary, ask for advice, and save theinformation, respectively.

Referring to FIG. 19, an exemplary selection process display 1900 isshown for the vertical dimension (matrix address position “B” in FIG.12)—anterior overbite component. A series of images of referenceconditions 1901-1903 are displayed in conjunction with buttons 1904allowing the images to be scrolled to the left or right. A user clicksthe left or right arrow buttons 1904 to select the image of thereference dentition condition that best reflects the patient's currentcondition. In this exemplary embodiment, a user clicks the left or rightarrow buttons 1904 to select the anterior vertical overbite relationshipcomponent that is similar to a patient's degree of open or deep bite.

Once the selection is made, the next button 1905 is pressed to move ontothe next display, which is illustrated in FIG. 20. The exemplaryselection process display 1900 also includes buttons 1906-1909 to allowa user to go back, access a glossary, ask for advice, and save theinformation, respectively.

Referring to FIG. 20, an exemplary selection process display 2000 isshown for the horizontal/transverse dimension (matrix address position“C” in FIG. 12)—upper and lower midline components. An image 1010representing a reference dentition condition is altered by clicking theupper arrows 2001-2002 corresponding to the upper arch of the image2010, and by clicking the lower arrows 2003-2004 corresponding to thelower arch of the image 1010 to best match the midline of the image 2010to a patient's midline component relationship. Once the selection ismade, the next button 2005 is pressed to move onto the next display,which is illustrated in FIG. 21. The exemplary selection process display2000 of FIG. 20 also includes buttons 2006-2009 to allow a user to goback, access a glossary, ask for advice, and save the information,respectively.

Referring to FIG. 21, an exemplary selection process display 2100 isshown for the upper arch length category. An image of a referencedentition condition 2101 and descriptions of reference dentitionconditions 2102, 2103 are displayed in association with buttons 2104allowing the reference dentition condition image and descriptions to bescrolled to the left or right. A user clicks the left or right arrowbuttons 2104 to select the image or description of the referencedentition condition that best reflects the patient's current condition.In this exemplary embodiment, a user clicks the left or right arrowbuttons 2104 to select the image or description of the referencedentition condition that is similar to a patient's upper arch lengthfrom the occlusal view. In this particular embodiment, if there is bothcrowding and spacing present, a user is instructed to use the net amountof crowding or spacing, but it may be possible to have each aspectcaptured independently.

Again, once the selection is made, the next button 2105 is pressed tomove onto the next display which is illustrated in FIG. 22. Theexemplary selection process display 2100 also includes buttons 2106-2109to allow a user to go back, access a glossary, ask for advice, and savethe information, respectively.

Referring to FIG. 22, an exemplary selection process display 2200 isshown for the arch length dimension (matrix position “D” in FIG.12)—lower arch length component. An image of a reference dentitioncondition 2201 and descriptions of reference dentition conditions 2202,2203 are displayed in association with buttons 2204 allowing thereference dentition condition image and descriptions to be scrolled tothe left or right. A user clicks the left or right arrow buttons 2204 toselect the image or description of the reference dentition conditionthat best reflects the patient's current condition for the lower archlength component of arch length. In this exemplary embodiment, a userclicks the left or right arrow buttons 2204 to select the image ordescription of the reference dentition condition that is similar to apatient's lower arch length from the occlusal view. In this example, ifboth crowding and spacing are present, the user is instructed to use thenet amount of crowding or spacing. It may be possible however to capturecrowding and spacing independently in order to derive the netdiscrepancy.

Once the selection is made, the next button 2205 is pressed to move ontothe next display, which is illustrated in FIG. 23. The exemplaryselection process display 2200 of FIG. 22 also includes buttons2206-2209 to allow a user to go back, access a glossary, ask for advice,and save the information, respectively.

FIG. 23 illustrates an exemplary patient summary tabulation 1300 foroutput display on terminal 1101 for use in the indexing system inaccordance with one embodiment of the present invention. The exemplarypatient summary display 2300 is generated from the information inputfrom previous displays 1600-2200, as illustrated in corresponding FIGS.16-22, respectively. Referring to FIG. 23, the selections made duringthe processes and displays described above and illustrated inconjunction with FIGS. 16-22 are summarized as shown in the summarydisplay 2300 in one embodiment of the present invention.

For example, for each reference dentition category including sagittal,vertical, horizontal and arch length, the corresponding malocclusionreference component (for example, right canine, anterior overbite, uppermidline relative to lower midline, and lower arch length, respectively),and each of which is associated with a selected one of the pre-definedoptions (for example, right canine partial Class 2, moderate anteriordeep bite, upper midline to left 0-1 mm, and lower moderate crowding,respectively). Also can be seen from FIG. 23 is the selected value ofthe selected pre-defined options 1203 (FIG. 12) as tabulated andillustrated in FIG. 12. The user is also able to edit the dentitioncondition information in each of the categories by selecting thecorresponding “EDIT” button to go back to the page desired andreselecting the image corresponding to that category.

In this manner, in one embodiment of the present invention, theinformation input by the user during the selection process is indexedand catalogued in a patient database (for example, the database 2400shown in FIG. 24 below) of the indexing system 1100. In one embodimentof the present invention, the selection process discussed in conjunctionwith FIGS. 16-22 for the indexing and cataloguing is transparent to theuser. The patient information input by the user in the selection processis used to generate both the summary display as illustrated in FIG. 23and an identifier representing the dentition conditions of the patient.FIGS. 16-22 illustrate the selection process display 1600 for use in theindexing system 1100 for various categories in accordance with oneembodiment of the present invention. This is the selection process forinputting a patient's dentition information. It will be appreciated thatalthough FIGS. 17-22 illustrate reference dentition conditionsrepresented by pictorial images, the present invention is not intendedto be limited to such representations. The reference dentitionconditions may also be represented by symbols, icons, descriptions,graphs, 3-D objects, radiographs, forms, and other types of images. Thereference conditions may also be user-defined through an interactivegraphical image such that the user best recreates the condition observedin the patient as a means of input for the system.

FIG. 24 illustrates a patient database 2400 for use in the indexingsystem 1100 in accordance with one embodiment of the present invention.The patient database 2400 includes a patient field 2401, an indexingdatabase address field 2402, and one or more category fields 2403. Inthe exemplary database of FIG. 24, the category fields 2403 include asagittal category field 2404, a vertical category field 2405, ahorizontal category field 2406, an upper arch length category field2407, a lower length category field 2408, a rotation field 2409, avertical correction field 2410, and a midline correction field 2411.

Referring to FIG. 24, the patient field 2401 includes the patient name.The indexing database address field 2402 includes the patientidentifier. This patient identifier corresponds to an address in theindexing database 1300, for example, as shown in FIG. 13. The address inthe indexing database 1300 is associated with treatment information forthat particular diagnostic combination. The category fields 2403, whichin this exemplary embodiment are the sagittal category field 2404, thevertical category field 2405, the horizontal category field 2406, theupper arch length category field 2407, the lower length category field2408, the rotation field 2409, the vertical correct field 2410, and themidline correct field 2411, include the patient's one or more dentitionconditions in the respective categories. For example, referring to FIG.24, patient L. Smith's dentition condition in the sagittal categoryfield 2404 is “Class I”. Patient M. Jones' dentition condition in theupper arch length category field 2407 is “normal”. The category fields2403 also indicate whether the particular reference condition iseligible for treatment (for example, shown by the Y/N indicator).

In this manner, the patient identifier may be configured to representthe patient conditions. For example, referring to the indexing databaseaddress field 2402, it is shown that L. Smith's identifier is“55772752”. Since the identifier includes eight positions, theidentifier is an eight-position matrix. The number in each position ofthe identifier represents a particular condition within a particularcategory. In this exemplary embodiment, the first position of theidentifier matrix represents the patient condition in the sagittalcategory. For example, the sagittal category field 2404 indicates thatL. Smith has a “Class I” malocclusion. Thus, the number 5 in the firstposition of the identifier represents a “Class I” malocclusion in thesagittal category.

Referring back to FIG. 24, the second position of the identifier matrixrepresents the patient condition in the vertical category. For example,the vertical category field 2405 indicates that L. Smith has normalocclusion. Thus, the number 5 in the second position of the identifierrepresents a normal occlusion in the vertical category. The thirdposition of the identifier matrix represents the patient condition inthe horizontal category. For example, the horizontal category field 2406indicates that L. Smith has a crossbite. Thus, the number 7 in the thirdposition of the identifier represents crossbite in the horizontalcategory.

Moreover, the fourth position of the identifier matrix represents thepatient condition in the upper arch length category. For example, theupper arch length category field 2407 indicates that L. Smith hasmoderate crowding. Thus, the number 7 in the fourth position of theidentifier represents moderate crowding in the upper arch lengthcategory. In addition, the fifth position of the identifier matrixrepresents the patient condition in the lower arch length category. Forexample, the lower arch length category field 2408 indicates that L.Smith has moderate spacing. Thus, the number 2 in the fifth position ofthe identifier represents moderate spacing in the lower arch lengthcategory.

In addition, the sixth position of the identifier matrix represents thepatient condition in the rotation category. For example, the rotationcategory field 2409 indicates that L. Smith has <20° rotation. Thus, thenumber 7 in the sixth position of the identifier represents <20°rotation in the rotation category. Further, the seventh position of theidentifier matrix represents the patient condition in the verticalcorrection category. For example, the vertical correct category field2410 indicates that L. Smith has no extrusion. Thus, the number 5 in theseventh position of the identifier represents no intrusion/extraction inthe vertical correction category.

Finally, referring yet again to FIG. 24, the eighth position of theidentifier matrix represents the patient condition in the midlinecorrect category. For example, the midline correct category field 2411indicates that L. Smith has >2 mm midline correction. Thus, the number 2in the eighth position of the identifier represents >2 mm midlinecorrect in the midline correction category.

In this manner, in one embodiment of the present invention, theconditions in the categories may be arranged in a predetermined ordereach associated with a numerical (for example “the number 2 in the eightposition of the identifier representing greater than 2 mm midlinecorrection in the midline correction category for patient L. Smith), ora predefined identifier such as, alphanumeric characters, symbols andthe like. In a further embodiment, the conditions in the categories maybe arranged in ascending order by difficulty and the categories aresorted in order of difficulty so that it is possible to define a matrixwhere 11111111 represents the mildest case and 33333333 is the mostsevere case in an eight position matrix identifier, for example asdescribed above. Additionally, each index in the matrix is weighted toderive a composite score of the overall case.

FIG. 25 illustrates an alternate embodiment of the present invention forcapturing an address in the selection process for use in the indexingsystem. FIG. 25 illustrates the table 1200 of FIG. 12 used directly as agraphical interface. In such embodiment, each reference condition asshown and illustrated in tabular format as rectangles may be representedas user input buttons with text which may be clicked to highlight andselect the appropriate reference condition. The assumption for this typeof interface is that the user understands the definitions of the text inorder to select the appropriate button. When the buttons are pressed toselect a particular reference condition, the selections are highlighted(shown in bold in FIG. 25). Clicking any button twice will deselect theinitial selection so that another selection can be made. In this manner,users who are more familiar with the various types of referenceconditions may be able to input the information more quickly thanthrough a visual-image based interface. In this example, the generatedaddress would be “3256.” The “Selected Value” column on the right sideof FIG. 25 is in one embodiment, transparent to the user/patient, andnot displayed to the user since the address has no relevance to the enduser, and is important only for the database query.

FIG. 26 illustrates an exemplary series of database addresses generatedby combining the initial condition address with the treatment goaladdress in one embodiment of the present invention. As indicated fromthe exemplary table 1200 of FIG. 12, there are 2,701 possible patientcase combinations or addresses for four components of seven possibleselection options each. Thus, an identifier address points to one of the2,701 possible combinations in the database. Each identifier isassociated with a field stored in a database of the storage unit 1107(FIG. 11). An identifier may be extended so that it represents thepatient's condition at different time points. For example, the databasemay be structured such that time points for initial dentition, targetdentition, and actual final dentition are captured as separateaddresses. For example, consider the following address:

-   -   ABCD: A*B*C*D*:A**B**C**D**

In this arrangement, the first four positions “A” to “D” of the matrixrepresent the patient's initial dentition (as previously described),positions “A*” to “D*” of the matrix represent the patient's targetdentition or treatment goal, and positions “A**” to “D**” of the matrixrepresent the patient's actual final dentition or treatment outcome.Because the number of positions in the matrix may be variable, and sinceeach position can include symbols, alphanumeric characters or otherrepresentations, the depth of individual patient cases that is stored ismay be detailed and specific to the patient and/or the associatedprofile or condition. Using the 4 possible treatment outcomesillustrated in FIG. 14 and the 2,701 possible combinations in FIG. 12,this equates to 2,701×4=10,804 possible paired combinations betweeninitial and goal.

FIG. 27 illustrates an exemplary database for a patient with an indexaddress of “3256” and the four possible treatment goals of 1 through 4.The resulting four combined addresses have different data for each ofthe parameters. This information is reported to the user either (1) uponcompletion of the case characterization, whereby all possible treatmentgoal options are presented to the user or (2) upon completion of thecase characterization and selection of a single treatment goal, wherebyonly the information from this address-goal pair is presented to theuser.

For each of these paired combinations, a combined address can becreated, with database assets in a “digital mailbox” associated witheach address. Assets for each digital mailbox can include, but is notlimited to: treatment plan information related to the case-treatmentgoal pairing, such as a text description of the treatment condition andgoals, treatment precautions, treatment length estimates, doctor skillset requirements, prescription data, sample case data, and casedifficulty. This data may be generated using expert opinion,computational algorithms, and/or historical case content.

For example, with respect to FIG. 23, where the case is identified as a“3256” and using the 4 types of treatment goals as shown in FIG. 14,combining the two yields four distinct database addresses: 3256:1,3256:2, 3256:3, and 3256:4. Each of the addresses can be populated withinformation specific to the case-treatment goal combination. All fouroptions can be simultaneously displayed to the user as “treatmentoptions” or the user can select a specific treatment goal and have asingle specific resulting treatment option data displayed. It is alsoconceivable that the user may also select any number of specific goals,and each of the data associated with each goal selected is reported tothe user depending on the initial condition parameters selected.

FIG. 28 illustrates a process 2800 for identifying a dentition problemor condition of a patient. The process 2800 is discussed more fully inconjunction with FIGS. 16-27. At step 2801, the user starts by enteringidentification information such as doctor and patient name, in additionto patient chief concern(s) (FIG. 16). In one embodiment, thiscomparison may be performed by the central server 1109 (FIG. 11) basedon information received, for example, from the terminal 1101, and/orbased on stored information retrieved from the data storage unit 1107.This and other related transactions in the process may be performed overa data network such as the internet via a secure connection. The userthen selects one of two user interfaces to input the patient's dentalcondition. The preferred method for the novice user is the visual-userinterface (FIG. 17-22) shown as step 2802. The advanced user will likelyprefer the alternative user interface (FIG. 25) illustrated as step2803.

Referring to FIG. 28, at step 2804 an initial dentition condition of apatient in each category is compared to one or more reference conditionsin the same category. After comparing the initial dentition condition ofthe patient in each category to one or more reference conditions foreach respective category, at step 2804, the selected reference conditionsimilar to the initial patient condition in the same category isreceived. Thereafter, at step 2805, the patient identifier is thengenerated based on the combination of alphanumeric characterscorresponding to the selected reference conditions. Edits can be made tothe inputs during the summary page review (step 2804) until the user issatisfied with the information submitted.

The output following the completion of the data input is a translationsummary (FIG. 23), which formats the user input into technicallyrelevant and correct terminology. At the same time, the user input isalso translated into a database address representing the current patientcondition (FIG. 25)—step 2805. Once the database address is created, theuser can choose to view all possible treatment options for this patient(OPTION 1), or specifically select a treatment goal and view thespecific goal associated with the user's selection (OPTION 2). To viewall the possible treatment options for the patient (OPTION 1), thedatabase (FIG. 27) is queried at step 2806, and all data associated withthe input address is presented to the user at step 2807 (END 1).

Referring back to FIG. 28, if the user desires to select a specificgoal, the specific goal is first defined by the user through a selectioninterface at step 2808 (FIG. 13), and the selection is then translatedinto a database address at step 2809 (FIG. 14), and the two addresses(patient condition and treatment goal) merged to create a combinedaddress or index at step 2810 (FIG. 26). This combined address is thenused to query the database at step 2811 (FIG. 27) in order to producedata specific to a single patient condition-treatment goal combinationat step 2812 (END 2).

For OPTION 2, it may also be possible that the user can select multiplegoals and only the data specific to those selected goals be produced forthe user. Once the user has reached END 1 or END 2, the user has theoption to purchase the product for the purpose of any one of theselected treatment goals, by selecting a pre-populated or semi-populatedtreatment prescription which can be part of the output data presented tothe user through this experience.

As discussed above, the user interface can provide one or more patientcases from the indexing database that matches the patient problem.Additionally, a range of patient cases from the indexing database thataddress specific components of the patient's problem can be provided. Inthis manner, in one embodiment of the present invention, search toolsmay be created to run statistics using the patient identifiers. Forexample, one search request may be to find all 131X cases. In thisexemplary search request, X represents any character in the fourthposition of the address. Thus, the search request would be to find allpatient identifiers having “131” as the first 3 digits of their patientidentifier address.

By labeling historically treated cases with this identificationmethodology, a catalog of orthodontic treatment can be created forfuture reference when planning treatment and assessing treatmentoutcomes. The result is a front-end user interface for capturing thedescription of an orthodontic condition and classifying the orthodonticcondition in a systematic scalable way. Referring again to FIG. 28, oncethe identifier is generated at step 2805, one or more treatment optionscan be determined using information generated from a database query. Thegenerated one or more treatment options may be stored in the datastorage unit 1107 (FIG. 11), and also, be provided to the terminal 1101for display on the display unit.

Given the diagnosis and treatment planning of orthodontic treatments caninclude a significant subjective component that may vary depending uponthe doctor's preferences and level of training, the indexing systemprovides a comprehensive, robust, and a substantially objective approachto establishing the patient diagnosis, treatment goal, and treatmentplan. The patient identifier of the present invention which representsthe patient's case, as well as the target treatment goal and finaloutcome enables treatment outcome profiles to be objectively catalogued,and for the catalog to be evaluated based on probabilities anddistributions. Indices such as prognosis and case difficulty can beassigned to matrix combinations, enabling similar cases to be treatedlike similarly successful cases. Treatment options may be correlated forcompleteness and ease of use. Treatment products, such as appliances,may be associated with specific matrix combinations so that theirsuggested use is more closely tied to a successful outcome.

Within the scope of the present invention, other embodiments forinputting a patient's dentition condition are also contemplated. Forexample, a configurable three-dimensional model may be used to input theinformation. In such embodiment, the user may recreate the patientdentition condition for the dimension. Alternatively, athree-dimensional graphics model may be staged to represent the entirerange of possible reference conditions for any given dimension. In suchembodiment, a user manipulates a slider to match a stage of the rangewhich is closest to the actual patient condition.

It will also be appreciated that this method of objectivelycharacterizing a case according to individual components is not limitedto the time points of pre-treatment, treatment goal, and post-treatment,and that any time point during treatment and following treatment may bealso catalogued in a similar fashion using the same input and databasesystem.

It will also be appreciated that in this exemplary embodiment althoughonly one reference condition is discussed as being selected for aparticular category, the present invention is not intended to be solimiting. The selection of one or more reference conditions within eachcategory is within the scope of the present invention.

Accordingly, a method for characterizing a dentition of a patient in oneembodiment of the present invention includes comparing an initialpatient condition in each of a plurality of dentition categories withone or more reference conditions in each of the plurality of dentitioncategories, where each of the one or more reference conditions has acorresponding representation, selecting at least one reference conditionin one or more of the plurality of dentition categories, where eachselected reference condition is similar to the initial patient conditionin a same dentition category, and generating a patient identifier basedon the corresponding representations of each selected referencecondition.

In one aspect, the plurality of dentition categories may include atleast two of: sagittal, vertical, horizontal, upper and arch lengthdimensions, or a number of a tooth in a dentition of a patient.

Moreover, the method may further include determining whether eachinitial patient condition is indicated for treatment based on treatmentinformation corresponding to the selected reference condition, providingone or more treatment options for each initial patient conditionindicated for treatment, where the one or more treatment options includeone or more of a treatment description, a treatment goal, a time tocomplete the treatment, a difficulty level, and a skill level tocomplete the treatment, an example of the treatment option.

Further, in another aspect, the method may also include comparing atleast a portion of the patient identifier with one or more referenceidentifiers, wherein each of the one or more reference identifiersincludes an initial reference dentition and a final reference dentition,selecting at least one reference identifier from the one or morereference identifiers, wherein the selected reference identifierincludes the portion of the patient identifier, and determining a finalpatient dentition based on the final reference dentition correspondingto the selected reference identifier.

A method for characterizing a dentition of a patient in accordance withanother embodiment of the present invention includes receiving aninitial dentition of a patient, generating an initial profilerepresenting the initial dentition of the patient, identifying aninitial malocclusion from the initial profile, and comparing at least aportion of the initial profile with one or more reference profiles ofreference dentitions, where said one or more reference profiles includesa reference malocclusion substantially similar to the initialmalocclusion at the beginning, during any treatment stage, or finaloutcome treatment position.

Also, the method may also include the step of selecting at least one ofthe one or more reference profiles, where said one or more referenceprofiles has a related final reference dentition.

Additionally, in a further aspect, the method also includes providing atarget dentition of the patient based on the final reference dentition.

The step of generating an initial profile in one embodiment may includevisually categorizing the initial dentition of the patient.

Moreover, the method may also include identifying one or more treatmentoptions associated with the one or more reference profiles.

A system for providing an orthodontic profile indexing system inaccordance with still another embodiment of the present inventionincludes a storage unit, and a controller unit operatively coupled tothe storage unit, and configured to compare an initial patient conditionin each of a plurality of dentition categories with one or morereference conditions in each of the plurality of dentition categories,where each of the one or more reference conditions has a correspondingrepresentation, select at least one reference condition in one or moreof the plurality of dentition categories, where each selected referencecondition is similar to the initial patient condition in a samedentition category, and to generate a patient identifier based on thecorresponding representations of each selected reference condition.

The controller unit may be configured to determine whether each initialpatient condition is eligible for treatment based on treatmentinformation corresponding to the selected reference condition, and toprovide one or more treatment options for each initial patient conditioneligible for treatment.

Also, the controller unit may be further configured to compare at leasta portion of the patient identifier with one or more referenceidentifiers, where each of the one or more reference identifiersincludes an initial reference dentition and a final reference dentition,to select at least one reference identifier from the one or morereference identifiers, where the selected reference identifier includesthe portion of the patient identifier, and to determine a final patientdentition based on the final reference dentition corresponding to theselected reference identifier.

In addition, a terminal may be operatively coupled to the controllerunit, and configured to transmit one or more of the initial patientcondition, where the terminal may be further configured to include adisplay unit.

A system for characterizing a dentition of a patient in accordance withstill another embodiment of the present invention includes a centralcontroller unit configured to generate an initial profile representingthe initial dentition of the patient, to identify an initialmalocclusion from the initial profile, and to compare at least a portionof the initial profile with one or more reference profiles of referencedentitions, wherein said one or more reference profiles includes areference malocclusion substantially similar to the initialmalocclusion.

In another aspect, a user terminal may be operatively coupled to thecentral controller unit, the user terminal configured to transmit theinitial dentition of the patient.

The central controller unit may be further configured to select at leastone of the one or more reference profiles, wherein said one or morereference profiles has a related final reference dentition.

In addition, the central controller unit may be further configured toprovide a target dentition of the patient based on the final referencedentition.

The central controller unit may be further configured to visuallycategorize the initial dentition of the patient.

Moreover, the central controller unit may be further configured toidentify one or more treatment options associated with the one or morereference profiles.

In yet still a further aspect, a storage unit may be configured to storeone or more of an initial profile an initial malocclusion, and areference malocclusion.

The various processes described above including the processes performedby the central server 1109 (FIG. 11) in the software applicationexecution environment in the indexing system 1100 including theprocesses and routines described in conjunction with the Figures may beembodied as computer programs developed using an object orientedlanguage that allows the modeling of complex systems with modularobjects to create abstractions that are representative of real world,physical objects and their interrelationships. The software required tocarry out the inventive process, which may be stored in the memory ordata storage unit 1107 of the indexing system or internally (not shown)within the central server 1109, may be developed by a person of ordinaryskill in the art and may include one or more computer program products.

While the characterization of adult dentition has been discussed inconjunction with the embodiments described above, the variousembodiments of the present invention may be used for thecharacterization of child dentitions. In addition, in accordance withthe embodiments of the present invention, the various aspects of thepresent invention may be manually implemented by the user, for example,using print-out documentation, visual graphics, and/or photographicimages of the conditions and/or treatment options, and further, mayinclude, within the scope of the present invention, manual computationor calculation of the results. In this manner, within the scope of thepresent invention, the various embodiments discussed above in thecontext of a computerized system for implementing the aspects of thepresent invention, may be implemented manually.

FIG. 29 is a flowchart illustrating the overall procedure for dynamicorthodontic treatment management in accordance with one embodiment ofthe present invention. Traditional orthodontic treatment assumes that atreatment goal is to ideal, when in fact, different treatment goals maybe desired. Instead of making the treatment goal open-ended, the oneembodiment of the present invention enables the user to select from oneor more pre-defined treatment goals to enable the user to select apredefined treatment goal from one or more predefined treatment goalsbased on a patient's initial condition, thereby creating a pairedcombination between the pre-selected treatment goal and the patient'sinitial dental condition. The pairing between the treatment goal and theinitial condition can then be linked to case related information, forexample, indexed in one or more databases for that particularcombination. This case related information may include, for example,doctor or clinician skill sets, case precautions, and assessment ofdifficulty for the particular combination.

In a further embodiment, the treatment goal may be open ended in afurther embodiment such that the user may be provided with one or moretreatment goals associated with the patient's initial orthodonticconditions, and where each of the one or more treatment goals may beassociated with parameters related to the particular one or moretreatment goals such as, for example, treatment difficulty assessment,treatment duration period, treatment appliance type, and the like.

Referring to FIG. 29, at step 2910, a patient's initial dentalcharacteristics are captured. More specifically, in one embodiment, thepatient's initial dental characteristics including, for example, thebite relationship, and severity of individual dental problems such asmalocclusions, for example, are captured and stored in a database. Inone embodiment, the initial dental characteristics may be manually inputby the doctor, the clinician, or the patient, based upon, for example,visual inspection of the patient's dental characteristics.Alternatively, a visual graphical interface such as, for example but notlimited to, a computer monitor, a personal digital assistant (PDA)graphical display unit, may be used to capture the initial dentalcharacteristics.

More specifically, in one embodiment, the doctor, clinician or patientmay be provided with a gradient of images on the visual graphicalinterface that show different dental conditions having varying degreesof differences. Then the doctor, clinician or the patient may visuallycompare the patient's dental characteristics with the gradient of imagesand select a corresponding one or more images from the gradient ofimages on the visual graphical interface. In this manner, the mostsimilarly matched images from the visual graphical interfacecollectively in one embodiment may comprise the patient's dentalcharacteristic diagnosis summary including each of the dental problemsidentified.

Referring back to FIG. 29, in a further embodiment, a three-dimensional(3-D) scan of the patient's teeth profile may be used in conjunctionwith the visual graphical interface as discussed above, to automaticallycapture the initial dental characteristics. This approach in oneembodiment may provide higher dental profile assessment consistency andaccuracy.

After the patient's initial dental characteristics are provided, theuser may provide a predefined treatment goal based on the patient'sinitial dental characteristics. In one embodiment, as illustrated inFIG. 29, the user selects a predefined treatment goal from one or morepredefined treatment goals based on feedback from a database query. Inparticular, after the patient's initial dental characteristics areprovided at step 2910, a query function is executed at step 2920 toperform one or more searches from one or more databases associated withdental characteristics and dental treatment goals created at step 2910based on the dental parameters. The query function enables a user tosearch for possible treatment goals based on the patient's initialdental parameters. A query function may also be executed at step 2920 toperform one or more searches from one or more databases associated withdental treatment plans based on one or more selected treatment goals andthe patient's initial dental parameters.

Referring again to FIG. 29, at step 2930, feedback from the queryfunction provides one or more case parameters associated with eithertreatment plan/profiles or treatment goals to the user. Based on the oneor more case parameters, the user may determine the most suitable ordesirable dental treatment goal or plan for the patient with thespecified initial dental characteristics. The case parameters mayinclude, for example, the type of appliances used for the treatment, thedifficulty of the treatment, and the duration of the treatment. Forexample, based on the one or more case parameters, a selection may bedetermined based on the type of appliances used for the treatment.

More specifically, referring back to step 2930 at (3A), in oneembodiment, one or more predefined treatment goals may be provided tothe user (doctor, clinician or the patient) based on the patient'sinitial dental parameters. In such embodiment, the predefined treatmentgoals may include common treatment goals associated with the patient'sinitial dental parameters. For example, some predefined treatment goalsare “pre-restorative setup”, which involves aligning the teeth inanticipation of future dental work on the teeth following one or moreorthodontic treatments; “esthetic alignment”, which involves aligningthe teeth for cosmetic improvement without altering the posterior biterelationship; “anterior function improvement”, which involves aligningthe teeth for improvement of the function and guiding relationship fromthe anterior teeth; and “optimal set-up”, which involves aligning theteeth to provide as optimal of a bite relationship as possible given thepatient's current initial dental characteristics.

In orthodontics there can be many different treatment goals whichsatisfy a patient's particular initial dental condition. Each of thesegoals may require different skills, and may have different prognosesdepending on the patient's initial dental characteristics. Theparticular embodiments of the present invention enables a user to selecta treatment goal based on case parameters associated with one or morepotential treatment goals. This assists the user in better selecting anappropriate treatment plan. In addition, because the information ispredefined for the initial dental characteristics/goal combination, theuser can be provided with real-time feedback regarding the impact ofchanges to the prognosis/outcome by varying or modifying the individualparameters for the treatment goal. Similarly, feedback can be providedto a user based on variations or modifications to the initial dentalparameters as well. In particular, the user may obtain modifiedtreatment plans as feedback based on modifications to the initial dentalparameters and/or modifications to a treatment goal.

Referring again to step 2930 at (3A), one or more treatment goals may beselected based on a difficulty rating. In such embodiment, each of theone or more predefined treatment goals may have an associated difficultyrating. For example, some doctors may have the skills or qualificationsto treat only certain types of dental conditions or to treat only up toa certain treatment difficulty rating level. Thus, having a difficultyrating associated with each of the predefined treatment goalscorresponding to the initial dental characteristics, may be helpful inassessing the impact of the treatment goal.

In a further embodiment, a maximum difficulty rating may bepre-designated for a particular user (for example, the doctor orclinician) such that the predefined treatment goals displayed asavailable to that user may include only those treatment goals up to themaximum pre-designated difficulty rating. In one embodiment, thedifficulty ratings may be associated with an alphanumeric scale, agraphical scale (including icons, colors, images and the like), anauditory scale, or one or more combined scale for ease of use.

For example, in one embodiment, three difficult ratings or levels may bedefined as follows: Difficulty level 1 (easy), difficulty level 2(moderate), and difficulty level 3 (severe). For example, a user notfamiliar with the dynamic orthodontic treatment management of thepresent disclosure initially may be comfortable with treatment goalshaving difficulty level 1 rating, and want to prescribe a treatment goalthat improves the patient's initial dental characteristics within an“easy” treatment plan.

In one embodiment, the user providing the pre-designated difficultyrating may include the patient having the initial dental characteristicsfor which orthodontic treatment is sought. In this manner, the patientmay be provided with the treatment difficulty rating based on theselected one or more treatment goals such that the patient mayselectively seek the suitable doctor or clinician with the appropriatelevel of treatment skills to perform the desired dental treatments.

Referring back to step 2930, at (3B) of FIG. 29, in one embodiment, thefeedback from the query function provided to the user can also includerating of treatment goals once an initial assessment is created. In suchembodiment, an assessment of treatment difficulty is done based on thecombination of the patient's initial dental condition and selected goal.For example, a treatment difficulty indicator of 1, 2, or 3 may beattributed to a given initial dental condition/treatment goalcombination, whereby “1” is a difficulty indicator of an “easy”combination, “2” is a difficulty indicator of a “moderate” combination,and “3” is a difficulty indicator of a “severe” combination. Difficultyindicators may also be associated with colors, symbols, and alphanumericcharacters.

In one embodiment a difficulty indicator may be based on, for example,one or more look up tables for each of the parameters associated withthe treatment of the patient's dental conditions. In one embodiment, theone or more lookup tables stored in the one or more databases, forexample, may be segregated by treatment goal, such that differentparameters of the patient's initial dental condition will be harder oreasier to treat depending upon the selected treatment goal.

In one embodiment, each of the one or more lookup tables may include apre-defined or pre-assigned difficulty indicator associated with eachtreatment related parameter, such that, a summation function of thedifficulty value (in the case of a numerical difficulty indicator, forexample) associated with each treatment related parameter may provide acomposite difficulty value. Alternatively, in one embodiment, thecomposite difficulty value may be determined by comparing the individualdifficulty values associated with all of the treatment parametersassociated with the patient's initial dental characteristic, andthereafter, selecting the most severe difficulty value or ratingassociated with the particular treatment goal for the given initialdental characteristics and associated treatment parameters.

For example, the table below illustrates a difficulty assessment orvalue associated with the different levels of upper crowding and theupper midline deviation. Upper Crowding (mm) 0 1 to 3 4 to 5 6 to 8 9+Difficulty 0 1 2 3 4 Upper 1 mm 2 mm 3 mm 4+ mm Midline Centered off offoff off Difficulty 0 1 2 3 4

From the table above, given a patient with initial dental conditionshaving 4 to 5 mm of upper crowding, and 1 mm upper midline deviation,the composite difficulty assessment may be determined by adding theindividual difficulty assessment for the upper crowding (difficulty=2)and the upper midline deviation (difficulty=1), to derive at a compositedifficulty assessment of three (3). Alternatively, as discussed above,the composite difficulty assessment or rating may be derived based upona comparison of each difficulty assessment associated with eachparameter, and thereafter, selecting the difficulty assessment or ratingthat is the most difficult based upon the comparison. For example,referring to the table above, comparing the difficulty assessment of two(2) associated with the upper crowding condition, with the difficultyassessment of one (1) associated with the patient's upper midlinedeviation, the composite difficulty assessment or rating may result at arating of two (2).

Referring again to FIG. 29, the determined composite difficultyassessment or rating associated with the patient's initial dentalcharacteristics and the related treatment parameters may be stored, forexample, in one or more databases, and further, correlated with anoverall difficulty assessment scale to determine the overall treatmentdifficulty. In one embodiment, the correlated overall difficultyassessment for the particular treatment may be provided to the user as,for example, a visual score. For example, in one embodiment, the overalltreatment difficulty may be provided to the user using one or more of analphanumeric output, a graphical output, an auditory output, or one ormore combinations thereof.

The use of a difficulty assessment enables a finite set of parameters todescribe a patient's orthodontic condition. In one embodiment, thedifficulty of moving a patient's orthodontic condition from one state toanother state with respect to each parameter is established in the formof a data table, in particular a difficulty table. In addition, thedifficulty assessment rating or value stored in the tables may depend ona particular appliance intended for resolution of a malocclusion.

Referring again to step 2930 at (3C) of FIG. 29, in one embodiment, thefeedback from the query function provided to the user can also includestatistical information. In such embodiment, similar historicallytreated combinations of the selected parameter/goal combination areanalyzed statistically to better inform the user. For example, in oneembodiment, this information may be obtained using a historicalcompilation of patients having similar initial dental conditions sortedby historical treatment and outcome information. Statistical analysis isthen performed on these historical data and the informationcategorically stored in one or more databases for query by the user.

More specifically, in one embodiment, the one or more databasesassociated with the execution of the query function (step 2920) asdescribed above may be configured to include a historical patienttreatment profile information and associated treatment relatedparameters including the respective patient initial dental conditions.In this manner, in one embodiment, one or more statistical analysis maybe performed to query the one or more databases which includeshistorical treatment information and associated parameters related to,for example but not limited to, the patients' initial dental conditions,the treatment goals, the treatment plans, and the treatment outcome.

Some examples of the historical treatment information stored in the oneor more databases discussed above include patient gender distribution,percentage and/or distribution of different treatment goals, average andactual treatment times, historical treatment success and associatedcriteria for determining successful treatments, one or more potentialcomplications associated with the particular treatment parameter, theinitial dental conditions, and associated or paired one or moretreatment goals.

To determine the statistical analysis objectively and accurately, in oneembodiment, cases of close similarity may be selected from the one ormore databases storing historical treatment information. In one aspect,the similarity of the cases (and the underlying patient conditions andassociated treatment parameters, for example) may be determined by usingpredefined one or more distance functions between two cases (that is,the current case under consideration and a historical case stored in theone or more databases including the historical treatment information).For example, the further the distance between the cases, the moresimilar the two cases.

In one embodiment, the distance function may be implemented by, forexample, a processing module in the dynamic orthodontic treatmentmanagement, which may be configured to generate a predetermined numberof closest matches to historical cases stored in the one or moredatabases including the historical treatment information. Morespecifically, in one embodiment, each parameter associated with theinitial dental condition and associated treatment goals and othervariables may be interrelated with each other based on a discretedistance determination, where the determined distance may be associatedwith the level of similarity between cases or parameters associated withthe cases under consideration.

For example, applying the distance function to a current case and ahistorical case, similarity in an initial condition parameter (forexample, incisor overjet) in the two cases under comparison may resultin a relative closer distance relationship than other initial conditionparameters. For example, if the initial condition parameter (forexample, incisor overjet) is the same in both the current and historicalcases, the distance between the cases is zero. That is, at least for theparticular parameter under consideration, the two cases are identical.Alternatively, the distance function may be determined to be close (forexample, on the order of one or two (as opposed to a substantially largenumber such as 100 which suggests a further distance relationshipbetween the two cases)) if the current case includes class 1, 2-3 mmincisor overjet as compared to the historical case stored in the one ormore databases which includes class 2, 3-5 mm incisor overjet.

For example, if a current case includes class 1, (2-3 mm incisoroverjet) as compared to the historical case stored in the one or moredatabases which includes class 2, (3-5 mm incisor overjet), it ispossible that values that were used to assign class 1 for current caseand historical case are 1.95 and 2.05, respectively, and very close toeach other. However they still belong to two different classassignments. Thus, one embodiment of the present invention allows anapproximate matching for this particular parameter if class assignmentconditions have common boundary. In the case where exact match of theparticular parameter does not exist, the contribution of the particularparameter in determining the distance function between the current andhistorical cases may be slightly further apart, and preference willstill be given to cases with exact match (if exists) when searching forsimilar cases. Moreover, another scenario where the approximate matchingmay be allowed includes cases where a particular parameter is lesscritical for the distance function when searching for similar cases.

In addition to the distance function, in one embodiment, each parameterunder consideration may be further associated with a weighted function,where in one embodiment, weights may be configured to indicate the levelof contribution of a particular parameter in combination with thedistance function between the cases. In one embodiment, parameters whichare more critical may be weighted more heavily and may be more importantwhen searching for similar cases. Alternatively, parameters which may beless critical may be weighted less heavily and may be less importantwhen searching for similar cases.

More specifically, depending upon the type of initial dental condition,the particular treatment goal or other associated parameters, certainaspects may be considered to be more important than others. For example,upper and lower arch length discrepancy, overbite, and overjet areconsidered relatively more important parameters than arch shape andpresence of rotated bicuspids, and accordingly, in one aspect, therelatively more important parameters may be weighted more heavily thancertain one or more relatively less important parameters such as archshape or the presence of rotated bicuspids. As such, certain one or moreof the important parameters may be weighted more heavily than certainone or more other relatively less important parameters. Moreover, in oneembodiment, certain one or more parameters may be considered to becritical parameters such that the weighted value (and thus thepossibility of potential possible deviation in determination of similarparameters in historical cases) may be substantially unmodifiable.

Moreover, in one embodiment, each of the parameters under considerationfor each case under review may be interrelated to each other. Therefore,in one embodiment, a distance function determination and a correspondingweighted assessment may have a direct or indirect impact upon thepreviously determined distance function or the weighted assessment, suchthat a dynamically modifiable parameter assessment is obtained.

In one embodiment, the parameters under consideration may be classifiedor defined as follows: (1) parameters that require exact match betweencases; (2) parameters that require exact match between cases dependingupon the selected treatment goal; (3) query criteria restrictionsincluding, for example—all cases for searching should be completedcases, ClinCheck® accepted cases; cases with or without additionalaligners needed, completed or incompleted cases, and product ororder-specific type cases, including for example, mid-course correctionor case refinement; and (4) parameters that require approximatematching. It should be noted that while certain exemplary parameters andassociated criteria for the query function is described herein, theexamples provided herein are intended to be non-exclusive examples, andother relevant parameters and criteria may be included within the scopeof the present invention.

In this manner, in one embodiment, similar cases may be selected bycomparison of individual parameters, for example, between the currenttreatment case under consideration and the parameters of eachhistorically treated or generated cases stored in the one or moredatabases. As discussed above, the parameters that are considered moreimportant or critical are weighted more heavily, and are determined tobe more important during the execution of the query function, whileparameters which are less critical are weighted less heavily and aredetermined to be less important during the execution of the queryfunction.

Referring back to FIG. 29, after receiving the feedback information atstep 2930 associated with the one or more treatment goals for theunderlying initial dental condition and the associated treatmentparameter information, at step 2940, the user (for example, the doctor,clinician or the patient) may select one of the pre-defined treatmentgoals received as the desired or intended treatment direction. Forexample, in the case where the treatment duration is an importantcriterion, the user may select the one or more relevant treatment goalshaving the shortest treatment duration period given the underlyinginitial dental condition. Within the scope of the present invention, theuser may select one or more pre-defined treatment goals as the desiredtreatment direction, including but not limited to, the treatmentduration period as discussed above, the treatment appliance type (forexample, Invisalign® aligners, brackets, a combination, and so on), theskill level necessary for treatment, probability of treatment success,estimated treatment length, estimated cost of treatment, and any othertreatment goals or combinations thereof.

After selecting the one or more desired pre-defined treatment goals, theuser may be provided with a treatment plan. In one embodiment, thetreatment plan is provided as a prescription template on the visualguide interface. More specifically, referring to FIG. 29, at step 2950,the dynamic orthodontic treatment management system may be configured togenerate and output a sequence of prompts for information to generate aprescription associated with the treatment plan based on the selectedone or more pre-defined treatment goals. The content that is presentedto the user is customized for the user depending on the treatment goalselected. In one embodiment, the prescription template displayed on thevisual guide interface may be pre-customized based upon the user inputinformation associated with the initial dental characteristics,associated treatment parameters and goals and other information that isnecessary to complete the treatment prescription. In this manner, in oneembodiment, information that is relevant and necessary is solicited fromthe user, while redundant information is not prompted for user input.For example, if the patient's bite profile is determined to be in thecorrect position, a prompt query asking whether a correction of the biteis desired is not necessary, and thus not generated for output to theuser.

In one embodiment, the prescription templates may be generated, storedand retrieved for subsequent use. In this manner, the doctor orclinician may efficiently generate complete prescriptions to treatorthodontic related cases based on their particular preferences fortreatment of specific types of cases, and thus are provided with anopportunity to use the same information consistently for treatment ofsimilar types of cases, and are not required to provide the sameinformation each time a prescription is required. Moreover, in oneembodiment, while certain information may be repeated for similar typesof cases in the prescription templates, the doctor or clinician may bealso provided with an option to modify the pre-stored and retrievedinformation so as to possibly customize the particular prescriptiondepending upon the treatment case under review.

Referring again to FIG. 29, upon completing the prescription for thetreatment of the initial dental conditions in view of the selectedtreatment goals and other desired treatment associated parameters, theorder associated with the prescription may be generated for placement atstep 2960 during which, in one embodiment, a virtual setup of thepatient's teeth based on the completed prescription is generated. Thevirtual setup of the patient's teeth may be verified for accuracy toconfirm the selected treatment parameters, for example, such as thedoctor or clinician's selected difficulty assessment associated with thetreatment. In one embodiment, the virtual set up may be verified withthe set up teeth movements and/or individual dental relationships, andthe treatment related parameters may be queried in the one or moredatabases or analyzed with a planned treatment assessment algorithm toconfirm if the expected difficulty assessment matches the expecteddifficulty level determined during the initial assessment, as discussedabove.

FIG. 30 is a flowchart illustrating a dynamic treatment planningprocedure in accordance with one embodiment of the present invention.Referring to FIG. 30, at step 3010 initial orthodontic conditions areprovided. For example, in one embodiment, the user which may include thepatient, the doctor, or the clinician, may provide a patient's initialdental characteristics using the visual guide interface discussed above.In one embodiment, the initial orthodontic conditions may includecharacteristics of the patient's every tooth, groups of teeth, oralternatively, characteristics of a select number of teeth for whichtreatment is desired. Thereafter, at step 3020 the desired one or moreorthodontic treatment goals are provided. In one embodiment, the one ormore orthodontic treatment goals are predefined. Based on theinformation provided, at step 3030, the user receives one or moretreatment plans associated with the initial orthodontic conditions andthe selected treatment goals. In one embodiment, such treatment plansare received in substantially real time.

Referring to FIG. 30, at step 3040 the user determines whether to modifyone or more parameters associated with the initial dental conditions. Ifit is determined that the initial dental conditions are not modified,then at step 3060 it is determined whether one or more parametersassociated with the treatment goals is modified. If it is determinedthat the initial orthodontic conditions and the treatment goals are notmodified, then the dynamic treatment planning procedure ends. However,if it is determined that one or more parameters associated with eitherthe initial orthodontic conditions or the treatment goals is modified,then at step 3050, a modified treatment plan is received.

FIG. 31 is a flowchart illustrating a dynamic treatment planningprocedure in accordance with another embodiment of the presentinvention. Referring to FIG. 31, in one embodiment, the initialorthodontic conditions and associated parameters are received at step3110, and at step 3120 the desired treatment goals are received.Thereafter, at step 3130, one or more databases are queried based on thereceived initial orthodontic conditions and associated parameters andthe desired treatment goals, and one or more treatment plans aregenerated. The generated one or more treatment plans are output to theuser and thereafter, at step 3140 it is determined whether any change tothe initial dental conditions parameters are changed. If it isdetermined that the initial dental condition parameters are not changed,then at step 3160 it is determined whether the treatment goal parametersare changed. If at step 3160 it is determined that the treatment goalparameters are not changed, then the dynamic treatment planningprocedure ends.

On the other hand, if it is determined at step 3140 that one or moreinitial orthodontic conditions are changed, or if it is determined atstep 3160 that one or more parameters associated with the treatmentgoals has changed, then at step 3150 the one or more databases arequeried based on the changed or modified parameters, and a modifiedtreatment plan is generated for output to the user. Thereafter, theprocedure returns to step 3140 and the procedure described above isrepeated until no additional changes to the initial orthodonticconditions or to the treatment goals are detected.

In this manner, in one embodiment, by providing the initial dentalcondition and a specified treatment goal pairing, a treatment plan isprovided that is associated with the case prognosis based on thespecified condition—goal pairing. Moreover, based on the receivedtreatment plan, the user may optionally modify one or more parametersassociated with the condition—goal pairing to determine a more desirableor suitable treatment plan that is within the specified treatmentparameters such as treatment difficulty, types of appliances, and thelike.

Accordingly, in one embodiment, the user may be provided with real timedental related treatment planning support that is substantiallyobjective. Moreover, the user may be provided with more comprehensivetreatment related information including the impact of individualtreatment goal parameters on the overall assessment of the treatmentplan associated with, for example, a particular dental appliance.

FIG. 32 is a flowchart illustrating dynamic treatment planning procedurein accordance with yet another embodiment of the present invention.Referring to FIG. 32, at step 3210 the initial orthodontic conditionsare provided, and at step 3220, one or more treatment goals arereceived. These one or more treatment goals include treatment profileparameters associated with the provided initial orthodontic conditions.Thereafter at step 3230, a treatment goal selection is provided whichincludes selected treatment profile parameters, and at step 3240 atreatment plan corresponding to the selected treatment goal is received.For example, in one embodiment, the patient's initial dentitioninformation may be provided using for example, the visual guideinterface, and thereafter, a plurality of treatment profile parametersassociated with the treatment option of the initial dentitioninformation is received. In one embodiment, the treatment goal mayinclude one or more of the following treatment parameters: treatmentdifficulty assessment, the appliance type available for treatment, thetreatment duration, and the like.

Upon receiving the treatment plan information associated with theselection of the treatment goal for the patient's particular dentitioninformation, at step 3250 the user may modify or change one or moretreatment parameters associated with the treatment plan information. Ifthe user modifies the one or more treatment parameters associated withthe treatment plan information, the procedure returns to step 3240 wherethe treatment plan based upon the modified or changed treatment planparameter is received. Thereafter, the user may further modify thetreatment parameters to determine corresponding change in the associatedtreatment plan. The procedure continues until no further changes to thetreatment profile parameters are made.

FIG. 33 is a flowchart illustrating a dynamic treatment planningprocedure in accordance with still another embodiment of the presentinvention. Referring to FIG. 33, at step 3310, the patient's initialorthodontic condition is received, and at step 3320, a plurality oftreatment goals, which include treatment profile parameters associatedwith the orthodontic condition, are retrieved and output to the user. Inone embodiment, the plurality of treatment profile parameters associatedwith the orthodontic condition may be retrieved based upon the executionof one or more query functions in the one or more databases as describedabove associated with the initial dental condition of the patient.

Referring again to FIG. 33, at step 3330, a treatment goal selection,which includes treatment profile parameters, is received, andthereafter, a corresponding treatment plan associated with the selectedtreatment goal and the initial orthodontic condition is generated andoutput to the user. Thereafter, it is determined at step 3350 whether amodification to the one or more treatment profile parameters of theselected treatment goal is detected. If it is determined that no changeto the treatment profile parameters are detected, then the procedureends. On the other hand, if it is determined at step 3350 that one ormore treatment profile parameter modifications is detected, then theprocedure returns to step 3340 and a corresponding treatment plan isgenerated and output to the user based on the detected modification tothe treatment profile parameters.

In this manner, in one embodiment, a feedback mechanism is providedwhere based upon an initial virtual setup of a patient's dentalconditions, a treatment assessment is provided which is configured toprovide a difference in the treatment plans based upon changes in thetreatment profile parameters such as, for example, differing treatmentgoals, differing treatment difficulty associated with each treatmentplan, or different types of appliances to be used for treatment.Accordingly, in one embodiment, by allowing modifications to thetreatment profile parameters, the user may readily and easily determinethe necessary skill level and other treatment related information, andthereafter, make suitable or appropriate changes to obtain the desiredtreatment. For example, in the case where the user determines that aparticular doctor is not skilled to perform the desired treatment, theuser may seek another doctor that has the necessary expertise forperforming the desired treatment. In addition, in one embodiment, basedupon the treatment profile parameters and the associated treatment plan,a recommendation of suitable skilled doctors may be provided to theuser.

Accordingly, in one embodiment, there is provided a substantiallyobjective manner in which to assess a patient's orthodontic conditions,and which may be configured to provide consistent and repeatable resultsor treatment plan recommendations, and to remove some or all of thesubjective assessment criteria based on manual assessment by doctors.

FIG. 34 is a flowchart illustrating a dynamic treatment profileassessment procedure in accordance with one embodiment of the presentinvention. Referring to FIG. 34, at step 3410 the initial orthodonticcondition information is provided and thereafter, an importanceassessment or rating information for each parameter associated with adesired treatment goal is provided at step 3420. For example, in oneembodiment, the user may provide information related to the patient'sinitial dental conditions, and thereafter, provide informationassociated with the desired treatment goal that is weighted orassociated with a predetermined importance rating using, for example,objective, predefined scaling.

Referring to FIG. 34, at step 3430, treatment plan information isreceived based upon the treatment goal with scaled parameters that hasbeen provided with importance assessment. Based on the receivedtreatment plan information, at step 3440 it is determined whether theimportance assessment or rating information is modified. If it isdetermined that the importance assessment associated with the treatmentplan is not modified, then the routine ends. On the other hand, if it isdetermined at step 3440 that the importance assessment or ratingassociated with one or more of treatment profile parameterscorresponding to the desired treatment goal is modified, then theroutine returns to step 3430 where the treatment plan information basedon the modified importance rating information is received.

In other words, in one embodiment, modification to the importanceassessment of a particular one or more treatment goal parametersassociated with the patient's dental conditions, in turn, modifies thecorresponding treatment plan information factoring in the modifiedimportance assessment associated with the treatment goal for thepatient's particular dental conditions.

FIG. 35 is a flowchart illustrating importance assessment of FIG. 34 inaccordance with one embodiment of the present invention. Referring toFIG. 35, in one embodiment at step 3510 one or more treatment goalparameters is received, and thereafter, a predefined scale ofinformation associated with the parameter importance assessment isreceived. For example, in one embodiment, the user may be provided withan objective criteria or scale by which to determine the respectiveimportance assessment associated with the one or more treatment profileparameters.

That is, in one embodiment, a numerical scale from 1 to 5 may beprovided to the user to correlate each of the one or more parametersassociated with the desired treatment goal. While a numerical scale isused, within the scope of the present invention, any other types ofsuitable scale that provides an objective criterion to determinerelative importance may be provided. Referring to FIG. 35, at step 3530each of the treatment goal parameters is associated with a desired orintended predefined scale. Based upon this importance assessment, thecorresponding treatment plan information is received (FIG. 34).

FIG. 36 is a flowchart illustrating a dynamic treatment profileassessment procedure in accordance with another embodiment of thepresent invention. Referring to FIG. 36, at step 3610 the initialorthodontic conditions of a patient are received, and thereafter, one ormore treatment goals and associated treatment goal parameters havingimportance assessments are received at step 3620. For example, in oneembodiment, one or more of the treatment goal parameters may beassociated with a predefined importance assessment scale. In thismanner, the treatment goal and the relative importance of one or more ofthe treatment goal parameters are received.

Referring to FIG. 36, at step 3630, a difficulty assessment ratingassociated with the treatment goal is determined and respectivetreatment plan information associated with both the treatment goal andthe initial dental conditions is output to the user. Thereafter, at step3640, it is determined whether any changes to the treatment goalparameters having importance assessment are detected. That is, based onthe treatment plan information, it is determined whether the user hasmodified any or all of the previously associated importance assessmentto the treatment goal parameters. If it is determined at step 3640 thatmodification to the treatment goal parameters importance assessment isnot detected, then the difficulty rating associated with the treatmentgoal parameters and the corresponding treatment plan information isstored in the one or more databases at step 3650, and the routine ends.

On the other hand, if it is determined that modification to thetreatment goal parameters importance assessment is detected, then theroutine returns to step 3630 to determine the difficulty ratingassociated with the treatment goal parameters with modified importancerating assessment. This routine is repeated until no modification to theimportance assessment associated with the treatment goal parameters isdetected.

In this manner, in one embodiment, treatment plan information includesfor example, treatment difficulty information that is associated with anecessary level of treatment skill required for performing thetreatment. If a doctor does not possess the necessary level of treatmentskill, in one embodiment, one or more parameters including an importanceassessment associated with the one or more parameters may be modifiedsuch that one or more treatment plans for treating the particular dentalconditions of the patient may be determined that are within the skilllevel of the doctor.

FIG. 37 is a flowchart illustrating dynamically weighted treatmentplanning assessment in accordance with one embodiment of the presentinvention. Referring to FIG. 37, at step 3710 the initial orthodonticcondition parameters are parsed. In one embodiment, the query functionmay be configured to parse the information associated with the initialdental characteristics received from the user into predeterminedcategories. Thereafter, at step 3720, each parsed orthodontic conditionparameter is associated with a relevance rating based on, in oneembodiment, a predetermined relevance or weighted function. At step3730, the received treatment goal parameters associated with theorthodontic condition is parsed by, for example, the query function,and, each treatment goal parameter is associated with a respectiverelevance rating at step 3740.

In one embodiment, the relevance rating for each of the initialorthodontic condition parameters and the treatment goal parameters maybe determined based on similarity of the each of the initial orthodonticcondition parameters and the treatment goal parameters to one or morepreviously treated cases or historical information associated with thecase profile or past treatment information related to the initialorthodontic condition parameters and the treatment goal parameters, forexample, as discussed above.

Referring again to FIG. 37, at step 3750 based on each relevance ratingassociated with the initial orthodontic condition parameters and thetreatment goal parameters, a corresponding treatment plan is generatedand output to the user. Thereafter, at step 3760 the generated treatmentplan information is stored in the one or more databases. In this manner,in one embodiment of the present invention, an objective relevancerating may be associated with one or more of the initial orthodonticcondition parameters and the treatment goal parameters to retrieve priortreatment profiles that includes the same or similar initial orthodonticcondition parameters and the treatment goal parameters, and based uponwhich the corresponding treatment plan may be generated.

FIG. 38 is a flowchart illustrating dynamically weighted treatmentplanning assessment in accordance with another embodiment of the presentinvention. Referring to FIG. 38, in one embodiment, at step 3810 theinitial orthodontic conditions are parsed into one or more predeterminedparameters. For example, in one embodiment the initial orthodonticconditions received may be parsed into some or all of the approximately25 diagnostic parameter categories. Thereafter, at step 3820 eachpredetermined parameter is associated with a corresponding weightedfunction. That is, as discussed above, the parameters associated withthe patient's dental conditions are weighted based upon a predeterminedcriteria, such as, for example, the importance of the particularparameter in relation to the overall desired treatment goal, thedifficulty of addressing the particular parameter in view of theavailable appliances for treatment, and so on.

Referring back to FIG. 38, at step 3830 the one or more databases isqueried based upon the one or more predetermined parameters associatedwith a corresponding weighted function, and at step 3840, a treatmentplan profile is generated based on the database query. As shown in FIG.38, the generated treatment plan profile is output to the user at step3850, and thereafter stored in the one or more databases at step 3860.

In this manner, in one embodiment of the present invention, eachparameter associated with the patient's dental condition may beevaluated based upon a predetermined weighted function and also, uponthe inter-dependencies of each parameter associated with the patient'sinitial dental condition, to determine the corresponding treatment planbased on, for example, previously treated cases that have similar or thesame characteristics associated with the patient's condition and/or thedesired treatment goal. Accordingly, in one embodiment, by identifyingsuccessfully treated prior cases and using parameters and informationassociated with the prior cases, users such as doctors, clinicians andthe patients may be provided with detailed relevant informationassociated with the treatment of prior similar cases in determining thetreatment direction.

FIG. 39 is a flowchart illustrating a predefined template manipulationin the overall procedure for dynamic orthodontic treatment management inaccordance with one embodiment of the present invention. Referring toFIG. 39, in one embodiment, information associated with the initialorthodontic conditions is provided at step 3910. Thereafter, thetreatment goal information associated with the initial orthodonticconditions is provided at step 3920. At step 3930, a predefined templatedisplay is received in, for example, the visual guide interface whichmay include, for example, information that has been pre-filled in. Thatis, based upon the information provided associated with the initialdental conditions and the selected treatment goal, a prescriptiontemplate may be received which includes some information that has beenautomatically added into the template.

Referring to FIG. 39, at step 3940, information is provided in thepredefined template display to complete the one or more data entryfields which are necessary to complete the prescription for thetreatment of the patient's dental conditions in view of the selectedtreatment goal. Thereafter, at step 3950 treatment plan information isreceived which is associated with the patient's dental conditions andthe selected treatment goal for the dental conditions.

FIG. 40 is a flowchart illustrating a predefined template manipulationin the overall procedure for dynamic orthodontic treatment management inaccordance with another embodiment of the present invention. Referringto FIG. 40, at step 4010 the initial orthodontic conditions are receivedand the treatment goal information associated with the patient's dentalconditions is received at step 4020. Thereafter at step 4030, it isdetermined whether there is a predefined template display associatedwith the treatment goal information received. That is, in oneembodiment, the one or more databases are searched to determine if thereis a suitable or appropriate predefined template display associated withthe selected treatment goal.

If it is determined that there is no predefined template display, thenat step 4040 a predefined template display is generated and output tothe user. In one embodiment, the predefined template display may begenerated to include information in one or more select data fieldsassociated with the patient's dental conditions or the selectedtreatment goal. On the other hand, if it is determined at step 4030 thata predefined template display associated with the selected treatmentgoal information is in the one or more databases, then at step 4050 thedetermined predefined template display is retrieved in addition to theinformation in one or more select data fields associated with thepredetermined template display and associated with the patient's dentalconditions or the selected treatment goal, and thereafter the predefinedtemplate display is output to the user.

Referring back to FIG. 40, at step 4060, information associated with thepredefined template display is received, and when it is determined thatall of the necessary information is received to complete a treatmentprescription associated with the treatment goal for the patient's dentalconditions, then at step 4070, treatment plan information is generatedand output to the user.

In this manner, in one embodiment, the process of generating aprescription for orthodontic treatments may be simplified such that,using existing template information or generating an appropriatetemplate associated with a specific treatment goal, certain informationmay be retrieved and pre-filled into the prescription form template, forexample, the information that is associated with the patient's initialorthodontic condition, while other relevant information may be promptedfor input from the user. In one embodiment, the user may store theprescription information in the predefined template display format suchthat the user may retrieve the predefined template display for futuretreatment of similar types of cases. In a further aspect, the predefinedtemplate display may be associated with a particular one or more of anindexed or categorized value or score of the patient's initial dentalconditions, with the treatment goal, or with any other customizablecharacteristics, such that the user may retrieve the predefined templatedisplay for subsequent similar cases for treatment.

Systems and methods are disclosed providing a database comprising acompendium of at least one of patient treatment history; orthodontictherapies, orthodontic information and diagnostics; employing a datamining technique for interrogating said database for generating anoutput data stream, the output data stream correlating a patientmalocclusion with an orthodontic treatment; and applying the output datastream to improve a dental appliance or a dental appliance usage.

The achieved outcome, if measured, is usually determined using a set ofstandard criteria such as by the American Board of Orthodontics, againstwhich the final outcome is compared, and is usually a set of idealizednorms of what the ideal occlusion and bite relationship ought to be.Another method of determining outcome is to use a relative improvementindex such as PAR, IOTN, and ICON to measure degrees of improvement as aresult of treatment.

The present invention provides methods and apparatus for miningrelationships in treatment outcome and using the mined data to enhancetreatment plans or enhance appliance configurations in a process ofrepositioning teeth from an initial tooth arrangement to a final tootharrangement. The invention can operate to define how repositioning isaccomplished by a series of appliances or by a series of adjustments toappliances configured to reposition individual teeth incrementally. Theinvention can be applied advantageously to specify a series ofappliances formed as polymeric shells having the tooth-receivingcavities, that is, shells of the kind described in U.S. Pat. No.5,975,893.

A patient's teeth are repositioned from an initial tooth arrangement toa final tooth arrangement by making a series of incremental positionadjustments using appliances specified in accordance with the invention.In one implementation, the invention is used to specify shapes for theabove-mentioned polymeric shell appliances. The first appliance of aseries will have a geometry selected to reposition the teeth from theinitial tooth arrangement to a first intermediate arrangement. Theappliance is intended to be worn until the first intermediatearrangement is approached or achieved, and then one or more additional(intermediate) appliances are successively placed on the teeth. Thefinal appliance has a geometry selected to progressively repositionteeth from the last intermediate arrangement to a desired final tootharrangement.

The invention specifies the appliances so that they apply an acceptablelevel of force, cause discomfort only within acceptable bounds, andachieve the desired increment of tooth repositioning in an acceptableperiod of time. The invention can be implemented to interact with otherparts of a computational orthodontic system, and in particular tointeract with a path definition module that calculates the paths takenby teeth as they are repositioned during treatment.

In general, in one aspect, the invention provides methods andcorresponding apparatus for segmenting an orthodontic treatment pathinto clinically appropriate substeps for repositioning the teeth of apatient. The methods include providing a digital finite element model ofthe shape and material of each of a sequence of appliances to be appliedto a patient; providing a digital finite element model of the teeth andrelated mouth tissue of the patient; computing the actual effect of theappliances on the teeth by analyzing the finite elements modelscomputationally; and evaluating the effect against clinical constraints.Advantageous implementations can include one or more of the followingfeatures. The appliances can be braces, including brackets andarchwires, polymeric shells, including shells manufactured by stereolithography, retainers, or other forms of orthodontic appliance.Implementations can include comparing the actual effect of theappliances with an intended effect of the appliances; and identifying anappliance as an unsatisfactory appliance if the actual effect of theappliance is more than a threshold different from the intended effect ofthe appliance and modifying a model of the unsatisfactory applianceaccording to the results of the comparison. The model and resultingappliance can be modified by altering the shape of the unsatisfactoryappliance, by adding a dimple, by adding material to cause anovercorrection of tooth position, by adding a ridge of material toincrease stiffness, by adding a rim of material along a gumline toincrease stiffness, by removing material to reduce stiffness, or byredefining the shape to be a shape defined by the complement of thedifference between the intended effect and the actual effect of theunsatisfactory appliance. The clinical constraints can include a maximumrate of displacement of a tooth, a maximum force on a tooth, and adesired end position of a tooth. The maximum force can be a linear forceor a torsional force. The maximum rate of displacement can be a linearor an angular rate of displacement. The apparatus of the invention canbe implemented as a system, or it can be implemented as a computerprogram product, tangibly stored on a computer-readable medium, havinginstructions operable to cause a computer to perform the steps of themethod of the invention.

Among the advantages of the invention are one or more of the following.Appliances specified in accordance with the invention apply no more thanorthodontically acceptable levels of force, cause no more than anacceptable amount of patient discomfort, and achieve the desiredincrement of tooth repositioning in an acceptable period of time. Theinvention can be used to augment a computational or manual process fordefining tooth paths in orthodontic treatment by confirming thatproposed paths can be achieved by the appliance under consideration andwithin user-selectable constraints of good orthodontic practice. Use ofthe invention to design aligners allows the designer (human orautomated) to finely tune the performance of the aligners with respectto particular constraints. Also, more precise orthodontic control overthe effect of the aligners can be achieved and their behavior can bebetter predicted than would otherwise be the case. In addition,computationally defining the aligner geometry facilitates direct alignermanufacturing under numerical control.

A computer-implemented method in accordance with one embodiment of thepresent invention includes receiving one or more parameters associatedwith an orthodontic condition, receiving a treatment goal informationassociated with the orthodontic condition, providing a predefinedtemplate associated with the received treatment goal information,wherein the predefined template includes at least one the orthodonticcondition related information.

In one embodiment, providing the predefined template may includequerying a database based on the treatment goal information for thepredefined template, and generating the predefined template when it isdetermined during querying the database that the predefined template isnot stored in the database.

Also, providing the predefined template may include retrieving thepredefined template from a database for display to a user.

The method may also include generating a treatment plan informationbased on the information received in the predefined template, and alsomay include providing the treatment plan information to a user.

The method may further include receiving a modified treatment goalinformation.

In one aspect, the method may additionally include querying a databasebased on the modified treatment goal information, providing a modifiedpredefined template, where providing the modified predefined templatemay include generating the modified predefined template based on themodified treatment goal information associated with the orthodonticcondition.

In still another aspect, the method may also include storing themodified predefined template.

A computer-implemented method in accordance with another embodiment ofthe present invention includes receiving one or more parametersassociated with an orthodontic condition, receiving a treatment goalinformation associated with the orthodontic condition, searching adatabase for a predefined template associated with the orthodonticcondition and the treatment goal information, retrieving informationassociated with the orthodontic condition and the treatment goalinformation, completing at least a portion of the predefined templatewith the retrieved information, and providing the predefined templatecompleted with the retrieved information.

In one aspect, searching the database may include selecting from aplurality of predefined templates the predefined template associatedwith the orthodontic condition and the treatment goal information.

The method may further include generating a treatment plan informationbased on the information received in the predefined template.

A system in accordance with yet another embodiment includes a datastorage unit, and a data processing unit operatively coupled to the datastorage unit, the data processing unit configured to receive one or moreparameters associated with an orthodontic condition, to receive atreatment goal information associated with the orthodontic condition,and to provide a predefined template associated with the receivedtreatment goal information, wherein the predefined template includes atleast one the orthodontic condition related information.

The data processing unit may be configured to query the data storageunit based on the treatment goal information for the predefinedtemplate, and to generate the predefined template when it is determinedduring querying the database that the predefined template is not storedin the database.

The system may include a display unit operatively coupled to the dataprocessing unit, the data processing unit further configured to retrievethe predefined template from the data storage unit for display on thedisplay unit.

In one aspect, the data processing unit may be configured to generate atreatment plan information based on the information received in thepredefined template.

The data processing unit may further be configured to receive a modifiedtreatment goal information, where the data processing unit may beadditional also configured to query the data storage unit based on themodified treatment goal information, to provide a modified predefinedtemplate based on the query.

The data processing unit in yet another aspect may be configured togenerate the modified predefined template based on the modifiedtreatment goal information associated with the orthodontic condition.

Moreover, in still another embodiment, the data processing unit may beconfigured to store the modified predefined template in the data storageunit.

The data processing aspects of the invention can be implemented indigital electronic circuitry, or in computer hardware, firmware,software, or in combinations of them. Data processing apparatus of theinvention can be implemented in a computer program product tangiblyembodied in a machine-readable storage device for execution by aprogrammable processor; and data processing method steps of theinvention can be performed by a programmable processor executing aprogram of instructions to perform functions of the invention byoperating on input data and generating output. The data processingaspects of the invention can be implemented advantageously in one ormore computer programs that are executable on a programmable systemincluding at least one programmable processor coupled to receive dataand instructions from and to transmit data and instructions to a datastorage system, at least one input device, and at least one outputdevice. Each computer program can be implemented in a high-levelprocedural or object oriented programming language, or in assembly ormachine language, if desired; and, in any case, the language can be acompiled or interpreted language. Suitable processors include, by way ofexample, both general and special purpose microprocessors. Generally, aprocessor will receive instructions and data from a read-only memoryand/or a random access memory. Storage devices suitable for tangiblyembodying computer program instructions and data include all forms ofnonvolatile memory, including by way of example semiconductor memorydevices, such as EPROM, EEPROM, and flash memory devices; magnetic diskssuch as internal hard disks and removable disks; magneto-optical disks;and CD-ROM disks. Any of the foregoing can be supplemented by, orincorporated in, ASICs (application-specific integrated circuits).

To provide for interaction with a user, the invention can be implementedusing a computer system having a display device such as a monitor or LCD(liquid crystal display) screen for displaying information to the userand input devices by which the user can provide input to the computersystem such as a keyboard, a two-dimensional pointing device such as amouse or a trackball, or a three-dimensional pointing device such as adata glove or a gyroscopic mouse. The computer system can be programmedto provide a graphical user interface through which computer programsinteract with users. The computer system can be programmed to provide avirtual reality, three-dimensional display interface.

Various other modifications and alterations in the structure and methodof operation of this invention will be apparent to those skilled in theart without departing from the scope and spirit of the invention.Although the invention has been described in connection with specificpreferred embodiments, it should be understood that the invention asclaimed should not be unduly limited to such specific embodiments. It isintended that the following claims define the scope of the presentinvention and that structures and methods within the scope of theseclaims and their equivalents be covered thereby.

1. A computer-implemented method, comprising: receiving one or moreparameters associated with an orthodontic condition; receiving atreatment goal information associated with the orthodontic condition;and providing a predefined template associated with the receivedtreatment goal information, wherein the predefined template includes atleast one orthodontic condition related information.
 2. Thecomputer-implemented method of claim 1 wherein providing the predefinedtemplate includes: querying a database based on the treatment goalinformation for the predefined template; and generating the predefinedtemplate when it is determined during querying the database that thepredefined template is not stored in the database.
 3. Thecomputer-implemented method of claim 1 wherein providing the predefinedtemplate includes retrieving the predefined template from a database fordisplay to a user.
 4. The computer-implemented method of claim 1 furtherincluding generating a treatment plan information based on theinformation received in the predefined template.
 5. Thecomputer-implemented method of claim 4 further including providing thetreatment plan information to a user.
 6. The computer-implemented methodof claim 1 further including receiving a modified treatment goalinformation.
 7. The computer-implemented method of claim 6 whereinproviding the predefined template includes: querying a database based onthe modified treatment goal information; and providing a modifiedpredefined template.
 8. The computer-implemented method of claim 7wherein providing the modified predefined template includes generatingthe modified predefined template based on the modified treatment goalinformation associated with the orthodontic condition.
 9. Thecomputer-implemented method of claim 7 further including storing themodified predefined template.
 10. A computer-implemented method,comprising: receiving one or more parameters associated with anorthodontic condition; receiving a treatment goal information associatedwith the orthodontic condition; searching a database for a predefinedtemplate associated with the orthodontic condition and the treatmentgoal information; retrieving information associated with the orthodonticcondition and the treatment goal information; completing at least aportion of the predefined template with the retrieved information; andproviding the predefined template completed with the retrievedinformation.
 11. The computer-implemented method of claim 1 whereinsearching the database includes selecting from a plurality of predefinedtemplates the predefined template associated with the orthodonticcondition and the treatment goal information.
 12. Thecomputer-implemented method of claim 10 further including generating atreatment plan information based on the information received in thepredefined template.
 13. A system, comprising: a data storage unit; anda data processing unit operatively coupled to the data storage unit, thedata processing unit configured to receive one or more parametersassociated with an orthodontic condition, to receive a treatment goalinformation associated with the orthodontic condition, and to provide apredefined template associated with the received treatment goalinformation, wherein the predefined template includes at least oneorthodontic condition related information.
 14. The system of claim 13wherein the data processing unit is configured to query the data storageunit based on the treatment goal information for the predefinedtemplate, and to generate the predefined template when it is determinedduring querying the database that the predefined template is not storedin the database.
 15. The system of claim 13 further including a displayunit operatively coupled to the data processing unit, the dataprocessing unit further configured to retrieve the predefined templatefrom the data storage unit for display on the display unit.
 16. Thesystem of claim 13 wherein the data processing unit is furtherconfigured to generate a treatment plan information based on theinformation received in the predefined template.
 17. The system of claim16 further including a display unit operatively coupled to the dataprocessing unit, the data processing unit further configured to displaythe treatment plan information on the display unit.
 18. The system ofclaim 13 wherein the data processing unit is further configured toreceive a modified treatment goal information.
 19. The system of claim18 wherein the data processing unit is further configured to query thedata storage unit based on the modified treatment goal information, toprovide a modified predefined template based on the query.
 20. Thesystem of claim 19 wherein the data processing unit is furtherconfigured to generate the modified predefined template based on themodified treatment goal information associated with the orthodonticcondition.
 21. The system of claim 19 wherein the data processing unitis further configured to store the modified predefined template in thedata storage unit.